Shakya Akash, Sharma Ayush, Singh Vijay, Rathore Amisha, Garje Vinayak, Wadgave Venkatramana, Kakadiya Ghanshyam, Marathe Nandan
Department of Orthopaedics and Spine Surgery, Dr BAM Hospital, Mumbai, India
Department of Orthopaedics and Spine Surgery, Dr BAM Hospital, Mumbai, India.
Int J Spine Surg. 2022 Jun;16(3):505-511. doi: 10.14444/8249.
Preoperative lumbar epidural steroid injections (LESI) are known to be a risk factor for intraoperative dural tears in traditional spine surgery. However, whether the same holds true after minimally invasive surgery is debatable. The authors decided to investigate the incidence of complications in patients undergoing minimally invasive lumbar discectomy after a preoperative LESI.
A retrospective analysis was carried out on patients ages 21 to 65 years who underwent minimally invasive lumbar discectomy over 3 years between November 2017 and October 2020. These were classified into 2 groups based on the administration of an LESI within a year of surgery. Those receiving LESI were further subdivided on the basis of the proximity of the injection to the surgery. The complications encountered during and up to 6 months after the surgery were recorded. Various demographic variables were also noted.
A total of 315 patients were included in the study, of which 129 were in the LESI group and 186 were in the non-LESI group. The overall complication rate was 13.65%, with 17.83% in the LESI group and 10.75% in the non-LESI group ( = 0.07). Patients receiving an LESI were 2.49 times more likely to suffer from intraoperative dural tears compared to the other group (95% CI: 1.00-6.20, = 0.049). This was more prevalent in those who were administered an LESI within 3 months of the surgery (OR: 3.24, 95% CI: 1.12-9.40, = 0.03). However, the rates of other complications including infections were comparable.
A history of LESI within 3 months of the surgery is a risk factor of intraoperative dural tears. However, other complications, including infections, are not affected by a preoperative LESI.
A history of an LESI within 3 months of a proposed minimally invasive discectomy should make the surgeon extra-cautious of the risk of a dural tear.
术前腰椎硬膜外类固醇注射（LESI）已知是传统脊柱手术中术中硬脊膜撕裂的一个危险因素。然而，在微创手术后情况是否相同仍存在争议。作者决定调查术前接受LESI的患者在接受微创腰椎间盘切除术后的并发症发生率。
对2017年11月至2020年10月期间3年内接受微创腰椎间盘切除术的21至65岁患者进行回顾性分析。根据手术一年内是否接受LESI将这些患者分为两组。接受LESI的患者进一步根据注射与手术的接近程度进行细分。记录手术期间及术后6个月内遇到的并发症。还记录了各种人口统计学变量。
该研究共纳入315例患者，其中LESI组129例，非LESI组186例。总体并发症发生率为13.65%，LESI组为17.83%，非LESI组为10.75%（P = 0.07）。与另一组相比，接受LESI的患者术中硬脊膜撕裂的可能性高2.49倍（95%可信区间：1.00 - 6.20，P = 0.049）。这在手术3个月内接受LESI的患者中更为普遍（比值比：3.24，95%可信区间：1.12 - 9.40，P = 0.03）。然而，包括感染在内的其他并发症发生率相当。
手术3个月内有LESI史是术中硬脊膜撕裂的一个危险因素。然而，包括感染在内的其他并发症不受术前LESI的影响。
拟行微创椎间盘切除术3个月内有LESI史应使外科医生格外警惕硬脊膜撕裂的风险。
