Pre-Operative Epidural Steroid Injection Usage is Associated with Improved Post-Operative Mobility Following Spine Surgery

Introduction: Back pain is typically treated conservatively, but as symptoms progress, patients may elect to receive surgery. Though almost all patients who have undergone spine surgery have experienced a trial of conservative management, the impact of this pre-operative period on post-operative outcomes and patient mobility is not well understood. Using patient activity data captured by patient smartphones, we assessed the association between methods of conservative management and peri-operative patient activity.

Methods: A retrospective study involving 34 patients who underwent spine surgery between 2017 and 2021 was conducted. Daily steps taken by these patients were remotely collected from patient smartphones using a mobile application across a two-year peri-operative period and statistically normalized to enable inter-patient comparison. The electronic health record and associated patient encounters were queried for demographic variables, as well as the use of pre-operative conservative management methods, including physical therapy, oral steroids, and epidural steroid injections (ESI). Statistical comparisons were drawn using heteroskedastic t-tests.

Results: There were no differences in post-operative activity associated with physical therapy (p=0.182) and oral steroid medication (p=0.313). However, patients who received ESIs had a faster return to baseline activity levels and reached higher levels of post-operative activity than those who did not (p=0.024). 20 patients received ESIs before their surgery and 14 did not. The two groups did not differ significantly in age, BMI, Charlson comorbidity index, or type of surgery received (24 decompression, 10 fusion). Pre-operatively, the smartphone-captured mobility did not significantly differ between the groups. Over the course of one year after surgery, patients who received pre-operative ESI treatment experienced an average of 180 days [95% CI: 65, 170] with activity levels above their pre-operative baseline, compared to only 118 days [95% CI: 144, 216] in patients who did not receive pre-operative ESIs.

Conclusion : Our study indicates that the use of ESIs in the conservative management period was associated with improved recovery of mobility following surgery. We hypothesize that ESIs may have long-term anti-inflammatory and pain relief effects that translate to greater recovery. Further study is needed to expand our patient sample and analyze correlations with patient-reported pain.