背景:硬膜外类固醇注射(ESI)用于治疗多种病态中枢神经系统病变,被认为是合理安全的程序。这项研究旨在通过比较在手术前不久接受ESI的脊柱手术患者与在手术前不久未接受ESI的患者的结果来确定脊柱手术后的相对感染风险。
方法:本研究是一项回顾性队列研究,使用多机构医疗保健数据库,TriNetX,收集手术前6个月有或没有ESI的脊柱手术患者的数据.产生了两个队列:队列1包括在脊柱手术前六个月接受ESI的患者,队列2包括脊柱手术前6个月内没有ESI的患者.队列2中的患者使用常见的基线人口统计学具有与队列1中的倾向评分1:1匹配的倾向评分,合并症和脊柱手术适应症。用于分析的脊柱手术和手术包括用于任何目的的开放式手术,包括探索,减压,切除,翻修或活检。在脊柱手术/手术后的三个月内,比较了这两个队列中的多个结果。包括死亡的发生,手术部位感染,硬膜外和/或脊柱脓肿,和硬脑膜撕裂。
结果:脊柱手术前6个月的ESI与术后3个月硬膜外/脊柱脓肿的可能性显著降低相关。死亡率没有变化,对于在脊柱手术前六个月接受ESI的患者,脊柱手术后三个月内伤口感染或硬脑膜撕裂的鉴定。
结论:这些数据表明,硬膜外注射类固醇抗炎作用在手术前提供了超越症状缓解的益处。鉴于脊柱病变的退化通常是晚期的,而不是由身体的炎症反应纠正的,这很可能是防止身体的免疫系统在手术干预前的几个月过度激活,创伤性的侮辱,与没有干预相比,是保护性的,重要的是,无重大不良影响。
BACKGROUND: An epidural steroid injection (
ESI) is used to treat a number of morbid central nervous system pathologies and is considered a reasonably safe procedure. This study aimed to determine the relative infection risk after spinal surgery by comparing outcomes in spinal surgery patients who received an
ESI shortly prior to the surgery against those who did not receive an
ESI shortly prior to the surgery.
METHODS: The present study is a retrospective cohort study using a multi-institutional healthcare database, TriNetX, to collect data on patients who received spinal surgery with and without having had ESIs six months before surgery. Two cohorts were generated: Cohort 1 included patients who had received an
ESI in the six months prior to spinal surgery, and cohort 2 included patients who did not have an
ESI in the six months prior to spinal surgery. The patients in cohort 2 had propensity scores matched 1:1 to those in cohort 1 using common baseline demographics, comorbidities and spinal procedure indications. The spinal procedures and surgeries considered for the analysis included open procedures for any purpose, including exploration, decompression, resection, revision or biopsy. Multiple outcomes were compared across these two cohorts in the three months following the spinal procedure/surgery, including the occurrence of death, surgical site infection, epidural and/or spinal abscess, and dural tear.
RESULTS: An ESI in the six months prior to spinal surgery was associated with a significant decrease in the likelihood epidural/spinal abscess in the three months after surgery. There was no change in mortality, wound infection or identification of dural tear in the three months after spinal surgery for those who received an ESI six months before spinal surgery.
CONCLUSIONS: This data suggests that epidural steroid injections\' anti-inflammatory effects provide benefits before surgery beyond symptomatic relief. Given that the degeneration of spinal pathologies is typically advanced rather than corrected by the body\'s inflammatory response, it is likely that preventing hyperactivation of the body\'s immune system in the months preceding surgical intervention, a traumatic insult, is protective compared to no intervention and, importantly, without major adverse effects.