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%, P <.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, P <.001) and within less than 3 months (OR 1.46, 95% CI 1.24-1.72, P <.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.
Original language | English (US) |
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Pages (from-to) | 807-812 |
Number of pages | 6 |
Journal | Global Spine Journal |
Volume | 9 |
Issue number | 8 |
DOIs | |
State | Published - Dec 1 2019 |
Keywords
- corticosteroid
- durotomy
- epidural
- lumbar discectomy
- spine surgery
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
- Clinical Neurology