Vol.:(0123456789) 1 3 European Spine Journal https://doi.org/10.1007/s00586-020-06410-x ORIGINAL ARTICLE Preoperative lumbar epidural steroid injections administered within 6 weeks of microdiscectomy are associated with increased rates of reoperation Sarah Bhattacharjee 1  · Sean Pirkle 1  · Lewis L. Shi 2  · Michael J. Lee 2 Received: 30 September 2019 / Revised: 17 March 2020 / Accepted: 4 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Purpose Lumbar epidural steroid injections (LESIs) are widely utilized for back pain. However, as studies report adverse efects from these injections, defning a safe interval for their use preoperatively is necessary. We investigated the efects of preoperative LESI timing on the rates of recurrent microdiscectomy. Methods This study utilized the PearlDiver national insurance claims database. Microdiscectomy patients were stratifed by the timing of their most recent LESI prior to surgery into bimonthly cohorts (0–2 months, 2–4 months, 4–6 months). This frst cohort was further stratifed into biweekly cohorts (0–2 weeks, 2–4 weeks, 4–6 weeks, 6–8 weeks). The 6-month reoperation rate was assessed and compared between each injection cohort and a control group of patients with no injec- tions within 6 months before surgery. Univariate analyses of reoperation were conducted followed by multivariate analyses controlling for risk factors where appropriate. Results A total of 12,786 microdiscectomy patients were identifed; 1090 (8.52%) received injections within 6 months before surgery. We observed a signifcant increase in the 6-month reoperation rates in patients who received injections within 6 weeks prior to surgery (odds ratio [OR] 1.900, 1.218–2.963; p = 0.005) compared to control. No other signifcant diferences were observed. Discussion In this study, microdiscectomy performed within 6 weeks following LESIs was associated with a higher risk of reoperation, while microdiscectomy performed more than 6 weeks from the most recent LESI demonstrated no such asso- ciation with increased risk. Further research into the interaction between LESIs and recurrent disk herniation is necessary. Keywords Lumbar epidural steroid injections (LESIs) · Microdiscectomy · Reoperation · Injection timing Introduction Corticosteroid injections have been in use for over 60 years in pain management therapy for a variety of joint conditions due to their potency, efcacy, minimal invasiveness, and lack of dependency, particularly in the wake of the current opioid epidemic [1–3]. However, despite these benefcial qualities, it is known that the injections themselves are associated with a host of potential risks, including injection site infection, vasovagal reaction, infammation, and calcifcation [4, 5]. Though low in rate, these associated setbacks have resulted in growing concern regarding the efect of corticosteroid joint injections not only on periprocedural efects but also on postoperative outcomes. Recent studies have reported the adverse efects of corticosteroid joint injections on recurrent surgeries, revision surgeries, and surgical site infection, as corticosteroid joint injections have been linked to postop- erative infection in the knee [6] and higher rates of revision and infection in the shoulder [7– 9], while lumbar epidural steroid injections (LESI) have been associated with surgical site infection following lumbar fusion [10]. While corticosteroid injections have been linked to unde- sirable outcomes in various joints including the spine, their efect on reoperation rates following spine surgery is largely unexplored. Several studies have noted their deleterious efects on soft tissue healing, including tendon rupture and * Sarah Bhattacharjee Sarah.Bhattacharjee@uchospitals.edu 1 Pritzker School of Medicine, The University of Chicago, 924 E. 57th St., Suite 104, Chicago, IL 60637, USA 2 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, IL, USA