Influence of Epidural Steroid Injection on Adrenal Function

Overview

Journal Clin Orthop Surg

Specialty Orthopedics

Date 2019 Jun 4

PMID 31156770

Citations 3

Authors

Won Shik Shin

Dong Ki Ahn

Myung Jin Kim

Kyung Jun Cho

Young Rok Go

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: Our results suggest that concern should be raised about the influence of preoperative multiple ESIs on adrenal suppression in spine surgery patients.

Citing Articles

[Lumbar transforaminal epidural block for treatment of low back pain with radicular pain].

He Y, Chen L, Xu Z, Wang J, Liu B Nan Fang Yi Ke Da Xue Xue Bao. 2020; 40(12):1804-1809.

PMID: 33380385 PMC: 7835691. DOI: 10.12122/j.issn.1673-4254.2020.12.16.

To compare the analgesic efficacy of two different doses of epidural ketamine in chronic low back-pain patients: A randomised double-blind study.

Gupta R, Kaur H, Kaur S, Mahajan L, Kaur T Indian J Anaesth. 2020; 64(9):768-773.

PMID: 33162571 PMC: 7641091. DOI: 10.4103/ija.IJA_541_20.

Symptomatic COVID-19 infections in outpatient image-guided corticosteroid injection patients during the lockdown phase.

Chang C, Prabhakar A, Staffa S, Husseini J, Kheterpal A, Simeone F Skeletal Radiol. 2020; 50(6):1117-1123.

PMID: 33108512 PMC: 7590247. DOI: 10.1007/s00256-020-03656-w.

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