Single Versus Multiple Epidural Steroid Injections for Lumbar Radiculopathy: A Propensity Score-Matched Analysis of Surgical and Health Care Utilization
Joshua M. Wiener, Christopher D. Hamad, Autreen Golzar, Jonathan Droessler, Lauren Boden, Taylor Paziuk, Kyle Yang, David C. Kaelber, Nicholas M. Bernthal, William L. SheppardBackground:
Epidural steroid injection (ESI) is commonly used for lumbar radiculopathy, yet the longitudinal association between repeat ESI utilization and subsequent surgical intervention remains poorly defined. This study compared five-year surgical and health care utilization outcomes among patients receiving single
Materials and Methods:
A retrospective cohort study was performed using the TriNetX Research Network. Adults aged 18 to 80 years with lumbar radiculopathy who underwent lumbar ESI between 2015 and 2020 were identified. Patients were classified as receiving single ESI or multiple ESI using a six-month landmark design; patients undergoing lumbar surgery before the landmark were excluded. Propensity score matching was performed 1:1. Primary outcomes were lumbar discectomy and lumbar fusion up to five years after the landmark date. Secondary outcomes included opioid utilization, chronic pain, lumbar imaging, emergency department visits, anxiety, depression, opioid use disorder, and foot drop.
Results:
After matching, 13,967 patients were included in each cohort. Multiple ESIs were associated with higher five-year rates of lumbar discectomy compared with single ESI, 5.75%
Conclusions:
In this large propensity score-matched cohort of patients with lumbar radiculopathy, multiple ESIs were associated with higher five-year surgical utilization, particularly within the first two years, and with greater health care utilization among patients managed nonoperatively. These findings suggest that repeat ESI may identify patients with a more persistent clinical trajectory who may benefit from closer reassessment and timely multidisciplinary evaluation.