Timing Matters: Preoperative Lumbar Epidural Steroid Injection and Long-Term Outcomes Following Single-Level Posterior Lumbar Fusion.

Authors

Mark Miller, John Pignataro, Matthew Meade, Omar Sbaih, Ruchir Nanavati, Nithin Gupta, William DiCiurcio, Gregory Schroeder, Alexander R Vaccaro, Christopher Kepler, Barrett Woods

Published in

Global spine journal. Pages 21925682261493045. Oct 09, 2026. Epub Oct 09, 2026.

Abstract

Study DesignRetrospective Cohort Analysis.ObjectiveCESIs are a mainstay of nonoperative treatment for degenerative lumbar spine disease. As increasing numbers of patients undergo sPLF after receiving CESIs, understanding their impact on surgical outcomes is essential. The objective of the present investigation was to evaluate the association between preoperative corticosteroid epidural spinal injections (CESI) and postoperative outcomes following single-level posterior lumbar fusion (sPLF).MethodsA retrospective cohort study was performed using the TriNetX database. Patients undergoing sPLF were stratified by preoperative CESI exposure within 3 months of surgery. After 1:1 propensity score matching, 3,804 patients remained in each cohort. Outcomes included surgical site infection (SSI), pseudoarthrosis, and reoperation. Risk ratios (RR), 95% confidence intervals (CI), and Kaplan-Meier analyses were performed.ResultsPreoperative CESI was not associated with an increased risk of 90-day SSI (1.06% vs. 1.01%; RR 1.05, 95% CI 0.68-1.64; p=0.82). However, pseudoarthrosis occurred more frequently in the CESI cohort at 1 year (9.58% vs. 6.54%; RR 1.47; p<0.001), 3 years (11.20% vs. 7.55%; RR 1.48; p<0.001), and 5 years (11.81% vs. 8.10%; RR 1.46; p<0.001). Reoperation rates were not significantly different at 5 years (7.81% vs. 7.25%; RR 1.08; p=0.36). Kaplan-Meier analysis demonstrated earlier and sustained pseudoarthrosis following preoperative CESI. The number needed to harm was 33.ConclusionsPreoperative CESI within 3 months of sPLF was associated with increased long-term pseudoarthrosis, without increasing postoperative SSI and reoperation rates.

PMID:
42853982
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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