Do Preoperative Epidural Steroid Injections Increase the Risk of Postoperative Complications Following Cervical Disc Replacement?

Study design: Retrospective database analysis.

Objective: To determine whether any associations exist between the use of preoperative epidural steroid injections (ESIs) and postoperative complications following cervical disc replacement (CDR).

Summary of background data: Preoperative ESIs are a commonly used modality for patients with cervical spine pathology. Previous studies have demonstrated cervical ESIs to be associated with higher complications after anterior cervical discectomy and fusion. To date, there is little known about the impact of cervical ESIs on the postoperative outcomes after CDR.

Methods: The PearlDiver Database was queried for patients who underwent CDR between 2010 and 2022. Patients were stratified based on ESI use within 90 days prior to surgery. Propensity-score matching was used to account for baseline differences. Outcomes collected included 90-day complications, readmissions, and 2-year reoperation rates.

Results: Patients receiving preoperative ESI had significantly higher rates of postoperative urinary tract infections (3.2% vs. 1.6%, OR=2.03, P<0.001). Recurrent radiculopathy was more prevalent in the ESI group (63.1% vs. 16.1%, OR=9.02, P<0.001), and ESI patients experienced a higher rate of revision surgery within 2 years compared to control patients (7.8% vs. 2.4%, OR=3.50, P<0.001). Additionally, ESI patients experienced higher rates of emergency department visits at 30 days (6.2% vs. 4.8%, OR=1.31, P=0.020), and readmission rates at both 30 days (2.8% vs. 1.1%, OR=2.52, P<0.001) and 90 days (9.7% vs. 2.0%, OR=5.29, P<0.001) postoperatively.

Conclusion: Preoperative ESI within 90 days of surgery is associated with increased rates of postoperative complications, readmissions, and reoperation following CDR.