Preoperative Cervical Epidural Steroid Injections: Utilization and Postoperative Complications in ACDF, PCDF, and Decompression.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-06-07 DOI:10.1097/BSD.0000000000001645

Husni Alasadi, Joydeep Baidya, Yazan Alasadi, Zakaria Chakrani, Michael M Herrera, Nicole Zubizarreta, Brocha Z Stern, Jashvant Poeran, Saad B Chaudhary

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引用次数: 0

Abstract

Study design: Retrospective cohort study.

Objective: Identify factors associated with cervical epidural steroid injection (CESI) receipt before anterior cervical discectomy and fusion (ACDF), posterior cervical decompression and fusion (PCDF), or decompression; evaluate the association between CESI receipt and 90-day postoperative complications; and determine characteristics of CESI associated with complications.

Summary of background data: Previous literature has suggested that a preoperative CESI may increase the risk of postoperative complications. However, these studies were limited in the procedures and complications they evaluated.

Methods: The IBM MarketScan database was queried for patients aged 18 years or older who underwent ACDF, PCDF, or cervical decompression for disc herniation, stenosis, radiculopathy, myelopathy, and/or spondylosis without myelopathy between January 1, 2014 and September 30, 2020. CESI receipt within 12 months preoperatively, injection characteristics, and postoperative complications were extracted. Multivariable logistic regression models were used to investigate associations between patient characteristics and receipt of CESI, receipt of a CESI and each 90-day postoperative complication, and CESI characteristics and each 90-day complication.

Results: Among the unique patients who underwent each procedure, 20,371 ACDF patients (30.93%), 1259 (22.24%) PCDF patients, and 3349 (36.30%) decompression patients received a preoperative CESI. In all 3 cohorts, increasing age, increasing comorbidity burden, smoker status, and diagnosis of myelopathy were associated with decreased odds of preoperative CESI receipt, while female sex and diagnosis of radiculopathy and spondylosis without myelopathy were associated with increased odds. There were no meaningful between-group comparisons or significant associations between preoperative CESI receipt and any 90-day postoperative complications in multivariable models (all P>0.05).

Conclusions: This study elucidated the main determinants of CESI receipt and found no differences in the odds of developing 90-day postoperative complications, but did identify differential outcomes with regard to some injection characteristics.

Level of evidence: Level III.

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术前颈硬膜外类固醇注射：ACDF、PCDF 和减压术的使用情况和术后并发症。

研究设计回顾性队列研究：确定颈椎前路椎间盘切除融合术（ACDF）、颈椎后路减压融合术（PCDF）或减压术前接受颈椎硬膜外类固醇注射（CESI）的相关因素；评估接受CESI与术后90天并发症之间的关系；确定与并发症相关的CESI特征：以往的文献表明，术前接受 CESI 可能会增加术后并发症的风险。然而，这些研究对手术和并发症的评估有限：方法：对 IBM MarketScan 数据库中 2014 年 1 月 1 日至 2020 年 9 月 30 日期间因椎间盘突出、狭窄、根性病变、脊髓病和/或无脊髓病的脊椎病而接受 ACDF、PCDF 或颈椎减压术的 18 岁及以上患者进行查询。提取了术前 12 个月内的 CESI 接收情况、注射特征和术后并发症。采用多变量逻辑回归模型研究患者特征与接受 CESI、接受 CESI 与每种 90 天术后并发症、CESI 特征与每种 90 天并发症之间的关系：在接受每种手术的独特患者中，20371 名 ACDF 患者（30.93%）、1259 名 PCDF 患者（22.24%）和 3349 名减压患者（36.30%）接受了术前 CESI。在所有 3 个队列中，年龄的增加、合并症负担的增加、吸烟状态和脊髓病诊断与术前接受 CESI 的几率降低有关，而女性性别和诊断为无脊髓病的根性神经病和脊柱病与几率增加有关。在多变量模型中，术前接受CESI与任何90天术后并发症之间没有有意义的组间比较或显著关联（所有P>0.05）：本研究阐明了接受CESI的主要决定因素，并发现术后90天并发症的发生几率没有差异，但确实发现了一些注射特征的不同结果：证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.