Infection Following Fusion in Patients Receiving Spinal Injections First — Smoke or Fire?

This study found no difference, but we remain concerned.

Smart Practice: Consider waiting at least three months after lumbar epidural corticosteroid injection before performing decompression and fusion.

What’s the Claim?

A historically controlled but underpowered study using careful matching from an institutional registry suggested no increase in the risk of surgical site infections among patients who had a spinal corticosteroid injection <1 month or 1 to 3 months prior to surgery compared with patients who had no injections before surgery. A higher percentage of those who had injections at those time points had CSF leaks (11% and 7%, respectively) compared to those who had no injections (5%; p = 0.02). The authors claimed a number of other differences that seem likely to be related to spurious significance (making too many statistical tests at the p < 0.05 level), because many of the differences they “found” had little or no biologically plausible connection to injections (such as venous thromboembolism, opioid usage, or pooled odds of complications or readmissions).

How’s It Stack Up?