Departments of Orthopaedic Surgery, West Bloomfield, MI 48322, USA.
J Bone Joint Surg Am. 2013 Jun 5;95(11):961-4. doi: 10.2106/JBJS.L.00844.
Lumbar epidural steroid injections (LESIs) are frequently prescribed for the treatment of radiculopathy or neurogenic claudication arising from compression of spinal nerves. However, there is evidence suggesting that corticosteroids adversely affect bone strength by diminishing new bone formation and increasing bone resorption. Our study sought to assess whether LESIs increase the risk of subsequent vertebral body fracture.
A retrospective cohort study was conducted to compare patients receiving LESIs with a control group. A total of 50,345 patients with ICD-9 (International Classification of Diseases, Ninth Revision) diagnosis codes involving the spine were identified by searching a corporate database, and 3415 of these were found to have received at least one LESI. We randomly selected a study population of 3000 patients from the injected population, and we selected a matched cohort of 3000 patients from the non-injected group with use of propensity matching. The incidence of vertebral body fractures in each group was assessed with use of survival analysis.
There was no significant difference between the injected and non-injected groups with respect to age, predicted propensity score, sex, race, hyperthyroidism, or steroid use. In the survival analysis, an increasing number of injections was associated with an increasing likelihood of fractures. Each successive injection increased the risk of fracture by a factor of 1.21 (95% confidence interval, 1.08 to 1.30) after adjustment for covariates (p = 0.003).
The findings suggest that LESIs, like other forms of exogenous steroid administration, may lead to increased bone fragility. The added exposure to glucocorticoids resulting from LESI use may carry a greater risk than previously thought, suggesting that use of LESIs should be approached cautiously in patients at risk for osteoporotic fractures.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
腰椎硬膜外类固醇注射（LESI）常用于治疗因脊神经受压引起的神经根病或神经性跛行。然而，有证据表明，皮质类固醇通过减少新骨形成和增加骨吸收而对骨强度产生不利影响。我们的研究旨在评估 LESI 是否会增加随后发生椎体骨折的风险。
通过在公司数据库中搜索国际疾病分类第 9 版（ICD-9）诊断代码涉及脊柱的患者，进行了回顾性队列研究，共确定了 50345 例患者，其中 3415 例患者接受了至少一次 LESI。我们从注射人群中随机选择了 3000 名患者的研究人群，并使用倾向匹配从非注射组中选择了 3000 名匹配的患者。使用生存分析评估每组椎体骨折的发生率。
在年龄、预测倾向评分、性别、种族、甲状腺功能亢进或类固醇使用方面，注射组和未注射组之间没有显著差异。在生存分析中，注射次数的增加与骨折的可能性增加相关。在调整了协变量后，每次连续注射都会使骨折的风险增加 1.21 倍（95%置信区间，1.08 至 1.30）（p = 0.003）。
这些发现表明，LESI 与其他形式的外源性类固醇给药一样，可能导致骨脆弱性增加。由于 LESI 使用而导致的糖皮质激素暴露增加的风险可能比以前认为的更大，这表明在有骨质疏松性骨折风险的患者中应谨慎使用 LESI。
治疗水平 III。有关证据水平的完整描述，请参见作者说明。
