Department of Orthopedics, Seoul Sacred Heart General Hospital, Seoul, Korea.
Clin Orthop Surg. 2019 Jun;11(2):183-186. doi: 10.4055/cios.2019.11.2.183. Epub 2019 May 9.
Spinal diseases are self-limited or non-progressive in many cases. Epidural steroid injection (ESI) is a common nonsurgical treatment option for spinal pain. Despite concerns about complications of repeated steroid injection, few studies reported on the adrenal function of spine disease patients undergoing surgery after ESI. We investigated the influence of preoperative multiple ESIs on adrenal function in spine surgery patients.
This was a retrospective study with prospective data collection. Those who underwent elective spinal operations and had a history of multiple ESIs from January to June 2017 were selected as a study group. Those who underwent knee arthroplasty and did not have a history of ESI and any kind of steroid injection in other areas during 6 months before surgery were selected as a control group. Demographic data were compared to assess homogeneity between groups. We assessed the preoperative serum cortisol level (SCL) to compare the basal adrenal function between groups. Also, we assessed the elevation of SCL postoperatively to evaluate the adrenal response to the surgical stress in each group. For subgroup analysis, we divided all patients into normal (7-28 µg/dL) and subnormal groups according to SCL and analyzed risk factors of adrenal suppression with multivariate logistic regression test.
There were 53 patients in the study group and 130 in the control group. Age and sex were homogeneous between groups. There was significant intergroup difference in preoperative SCL (10.4 ± 4.8 µg/dL in the study group vs. 12.0 ± 4.2 µg/dL in the control group; = 0.026).The postoperative day one SCL was 11.6 ± 5.0 µg/dL in the study group without significant increase from the preoperative level ( = 0.117), whereas the increase was significant in the control group with a postoperative level of 14.4 ± 4.4 µg/dL ( < 0.001). Among all patients, the SCL was subnormal in 18 patients and within the normal range in 165. Spine surgery was the independent risk factor irrespective of age and sex (odds ratio, 3.472; = 0.015).
Our results suggest that concern should be raised about the influence of preoperative multiple ESIs on adrenal suppression in spine surgery patients.
许多脊柱疾病是自限性或非进行性的。硬膜外类固醇注射（ESI）是治疗脊柱疼痛的一种常见非手术治疗方法。尽管人们对重复类固醇注射的并发症存在担忧，但很少有研究报告 ESI 后脊柱疾病患者的肾上腺功能。我们研究了术前多次 ESI 对脊柱手术患者肾上腺功能的影响。
这是一项回顾性研究，前瞻性收集数据。选择 2017 年 1 月至 6 月期间接受择期脊柱手术且有多次 ESI 史的患者为研究组。选择同期接受膝关节置换术且术前 6 个月内无 ESI 史和其他部位类固醇注射史的患者为对照组。比较两组患者的人口统计学数据，以评估组间的同质性。我们评估了术前血清皮质醇水平（SCL），以比较组间基础肾上腺功能。同时，我们评估了术后 SCL 的升高情况，以评估每组患者对手术应激的肾上腺反应。对于亚组分析，我们根据 SCL 将所有患者分为正常（7-28μg/dL）和亚正常组，并采用多变量逻辑回归检验分析肾上腺抑制的危险因素。
研究组 53 例，对照组 130 例。两组患者的年龄和性别均无差异。术前 SCL 存在显著的组间差异（研究组 10.4±4.8μg/dL，对照组 12.0±4.2μg/dL； = 0.026）。研究组术后第 1 天的 SCL 为 11.6±5.0μg/dL，与术前水平无显著升高（ = 0.117），而对照组的 SCL 显著升高，术后水平为 14.4±4.4μg/dL（ < 0.001）。所有患者中，18 例 SCL 亚正常，165 例 SCL 正常。无论年龄和性别如何，脊柱手术都是独立的危险因素（优势比 3.472； = 0.015）。
我们的结果表明，术前多次 ESI 可能会对脊柱手术患者的肾上腺抑制产生影响，对此应予以关注。
