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Recent Preoperative Lumbar Epidural Steroid Injection Is an Independent Risk Factor for Incidental Durotomy During Lumbar Discectomy. | LitMetric

AI Article Synopsis

  • This study analyzed a large group of Medicare patients aged 65-85 who underwent lumbar discectomy to examine the link between lumbar epidural steroid injections (LESI) and incidental durotomy (ID).
  • Out of nearly 65,000 patients, those who experienced ID (2,369 patients) had a noticeably higher history of LESI compared to a matched control group (27.1% vs 35.0%).
  • The findings indicate that patients receiving LESI within 3 to 6 months before surgery had a significantly increased risk of ID, suggesting that timing of the injection is critical.

Article Abstract

Study Design: Retrospective review.

Objective: To investigate the association between lumbar epidural steroid injection (LESI) and incidental durotomy (ID) in patients with a diagnosis of disc herniation undergoing a primary discectomy.

Methods: A Medicare patient database was queried for patients between the ages of 65 and 85 years who underwent a primary lumbar discectomy for a diagnosis of lumbar disc herniation or degeneration from 2008 to 2014. Our main cohort of 64 849 patients was then divided into 2 groups: patients who experienced a dural tear (N = 2369) and our matched (age, gender, and history of diabetes) control cohort of patients who did not (N = 62 480). All patients who had a history of LESI were further identified and stratified into 4 subgroups by duration between LESI and discectomy (<3 months, 3-6 months, 6 months to 1 year, and overall), and a comparison of the relative incidence of ID was made among these subgroups. A multivariate logistic regression analysis was employed to determine the relationship between LESI and ID.

Results: Overall incidence of ID was 3.7%. There was a significant difference in incidence of LESI (27.1% vs 35.0%, < .001) between our control and ID groups. An adjusted odds ratio (OR) showed that prior LESI within 3 to 6 months (OR 1.47, 95% CI 1.20-1.81, < .001) and within less than 3 months (OR 1.46, 95% CI 1.24-1.72, < .001) of surgery were significantly associated with ID.

Conclusion: LESI increases the risk of ID in patients who undergo a subsequent lumbar discectomy within 6 months of injection.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882093PMC
http://dx.doi.org/10.1177/2192568219833656DOI Listing

Publication Analysis

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