Preoperative Epidural Steroid Injections and Surgical Site Infection Risk in Lumbar Spine Surgery: A Retrospective Cohort Study

Muhammad Waheed; Brandon Henry; Abdurrahman Ehsan; Andreea Geamanu; Chaoyang Chen; Rahul Vaidya; Anil Sethi

doi:10.7759/cureus.84892

Preoperative Epidural Steroid Injections and Surgical Site Infection Risk in Lumbar Spine Surgery: A Retrospective Cohort Study

Cureus. 2025 May 27;17(5):e84892. doi: 10.7759/cureus.84892. eCollection 2025 May.

Authors

Muhammad Waheed¹, Brandon Henry², Abdurrahman Ehsan³, Andreea Geamanu⁴, Chaoyang Chen⁴, Rahul Vaidya¹, Anil Sethi¹

Affiliations

¹ Orthopaedic Surgery, Detroit Medical Center Wayne State University, Detroit, USA.
² Orthopaedic Surgery, Michigan State University College of Osteopathic Medicine, East Lansing , USA.
³ Department of Biomedical Engineering, Wayne State University, Detroit , USA.
⁴ Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA.

Abstract

Background: Low back pain is a leading cause of work-related disability worldwide. Epidural steroid injections (ESIs) are commonly used as nonoperative treatments for patients with degenerative lumbar spine pathology. It is imperative to further elucidate the association between preoperative ESIs and postoperative outcomes in this population. This study seeks to evaluate the association between the timing of preoperative ESIs and the incidence of surgical site infections (SSIs) in patients undergoing lumbar spine surgery.

Methods: This retrospective study analyzed patients who underwent lumbar spine surgery from January 2020 to December 2021. Patients were stratified based on ESI status: no ESI, most recent ESI within three months preoperatively (early group), and most recent ESI equal to or greater than three months preoperatively (late group). All patients were followed for at least one year postoperatively to monitor for SSI. Bivariate correlation analysis using Spearman's rank correlation coefficient was performed to identify risk factors for SSI. Infection rates across ESI groups were compared using Pearson's chi-square test, Fisher's exact test, or the chi-square test of independence, selected based on sample size and expected cell counts.

Results: Among 94 patients, 49 received a preoperative ESI. Of these, 11 patients were in the early ESI group and 38 in the late ESI group. The overall infection rate was 2.2%, with one infection in each ESI subgroup. No significant difference in SSI rates was observed between the early and late ESI groups (p=0.171). Higher BMI, use of Disease-Modifying Antirheumatic Drugs (DMARDs), and higher American Society of Anesthesiologists (ASA) scores were associated with an increased SSI risk (p<0.05).

Conclusions: The timing of preoperative ESI does not significantly influence SSI risk in lumbar spine surgery. This study also highlights the role of elevated BMI, DMARD use, and ASA scores as potential risk factors for SSI in patients receiving preoperative ESI. Mitigating infection risk should focus on addressing modifiable factors such as BMI, DMARD use, and ASA scores rather than ESI timing.

Keywords: epidural steroid injection; lumbar fusion; lumbar spinal decompression; postoperative outcomes; surgical site infection.