Impact of Short-term Perioperative Steroid Administration on Outcomes of 1- and 2-Level Transforaminal Lumbar Interbody Fusion.

Study design: Retrospective observational cohort.

Objective: To assess the impact of short-term perioperative use of systemic steroids on the surgical outcomes of one- to two-level transforaminal lumbar fusion (TLIF), with a primary focus on complications.

Summary of background data: Steroids are commonly used in the perioperative period, including as a standard anesthesia practice and control for postoperative pain. However, the impact of perioperative use of systemic steroids on the surgical outcomes of lumbar fusion surgery remains unclear.

Methods: We retrospectively reviewed 560 patients who underwent one- or two-level TLIF. Complications rates within one year postoperatively were compared between the patients who received perioperative steroids and those who did not. Additionally, the total cumulative steroid dose as prednisolone equivalents was compared between patients with and without complications.

Results: 380 patients (68%) received steroids perioperatively, with a mean prednisolone equivalent dose of 110±341.3 mg. Intraoperative steroids were administered to 359 patients (64%), with a mean dose of 46.6±13.8 mg, while 45 patients (8%) received steroids postoperatively, with a mean dose of 558.1±863.5 mg. There were no significant differences in any complication rates between patients who received steroids perioperatively, postoperatively, or intraoperatively and those who did not, respectively. Patients who experienced complications had lower total cumulative steroid dose compared to those without any complications, and the differences reached to significant in infections (39.9±53.2 mg vs. 77.6±297.0 mg, P=0.015); minor complications (37.2±51.5 mg vs. 79.9±304.2 mg, P=0.005); and nonunion (49.8±78.1 mg vs. 89.1±336.5 mg, P=0.046).

Conclusion: This study found that short-term perioperative use of systemic steroids was not associated with increased complications, and perioperative administration of steroids may have potential protective effects.