Spine - 2026-04-15 - Journal Article
Do Preoperative Epidural Steroid Injections Increase the Risk of Postoperative Complications Following Cervical Disc Replacement?
Hameed Z, Vengsarkar VA, Green CK, Yalamuru B, Shimer AL, Lockey SD
Topics
Key Takeaway
Preoperative ESI within 90 days of CDR is associated with a 3.5-fold higher 2-year revision rate (7.8% vs. 2.4%) and 5.3-fold higher 90-day readmission rate compared to matched controls.
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Summary
This retrospective PearlDiver database study examined whether preoperative ESI within 90 days increases postoperative complication risk after CDR using propensity-score matched cohorts. ESI patients had significantly higher rates of UTI (3.2% vs. 1.6%), recurrent radiculopathy (63.1% vs. 16.1%, OR=9.02), 30-day ED visits (6.2% vs. 4.8%), 90-day readmission (9.7% vs. 2.0%), and 2-year revision surgery (7.8% vs. 2.4%, OR=3.50). The magnitude of the recurrent radiculopathy difference and revision rate elevation suggests preoperative ESI may identify a biologically or mechanically distinct patient subset with more refractory disease rather than ESI causing direct harm.
Key Limitation
The 63.1% vs. 16.1% recurrent radiculopathy disparity almost certainly reflects selection bias—patients receiving preoperative ESI had more severe or refractory radiculopathy at baseline—which propensity matching on administrative codes cannot adequately control.
Original Abstract
STUDY DESIGN
Retrospective database analysis.
OBJECTIVE
To determine whether any associations exist between the use of preoperative epidural steroid injections (ESIs) and postoperative complications after 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, little is 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 before 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). In addition, 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 after CDR.