| Objective To evaluate the safety and clinical efficacy of preoperative caudal epidural steroid injection (CESI) within 1 month on revision surgery for adjacent segment disease (ASDis) following lumbar fusion. Methods A total of 97 patients treated with posterior decompression fusion fixation and removal of existing internal fixation for ASDis from January 2015 to January 2022 in Wuhan Integrated Traditional Chinese and Western Medicine Hospital were retrospectively analyzed. Patients were divided into group A (no CESI, 51 cases) and group B (CESI, 46 cases) based on whether CESI was performed preoperatively. The group B was further subdivided based on the time of the last injection before revision surgery into group B1 (≤1 month, 21 cases) and group B2 (＞1 month, 25 cases). Surgical time, intraoperative blood loss, dural tear, postoperative infection, other complications and fusion were analyzed. Visual analogue scale (VAS), Oswestry disability index (ODI) preoperatively and at 1, 3, 12 and 24 months postoperatively were compared, and the 5-point Likert scale was used to evaluate the patients' satisfaction. Results There were no statistically significant differences in surgical time and intraoperative blood loss among the three groups (P＞0.05). The postoperative VAS scores and ODI in groups A, B1, and B2 showed significant improvement compared to preoperative levels, with statistical significance (P＜0.05). However, there was no statistically significant difference among the three groups (P＞0.05). During the postoperative and follow-up period, there were 4 cases (7.84%), 2 cases (9.52%), and 2 cases (8.00%) of dural sac tear in group A, group B1, and group B2, respectively. There were 2 cases (3.92%), 1 case (4.76%), and 1 case (4.00%) of postoperative infection who underwent secondary debridement surgery, respectively. After symptomatic treatment, all patients recovered. There was no significant difference in the incidence of postoperative cerebrospinal fluid leakage and wound infection among the three groups (P＞0.05). At the last follow-up, all patients showed no signs of adjacent vertebral disease or recurrence, and the intervertebral discs had already fused. During the 2-year follow-up after surgery, group A, group B1, and group B2 all achieved high satisfaction rates of 82.35% (42/51), 80.95% (17/21), and 84.00% (21/25), respectively, with no statistically significant difference (P＞0.05). Conclusion CESI injection within 1 month before surgery does not increase the risk of dural tears, bleeding, or postoperative infections. |
