Background: 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.Methods: 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.Results: 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 (P = 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, P = 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, P = 0.03). However, the rates of other complications including infections were comparable.Conclusions: 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.Clinical Relevance: 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.Level of Evidence: 3.

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Mixed connective tissue disease (MCTD) is a term involving the features of lupus systemic sclerosis, polymyositis, rheumatoid arthritis and high titre of anti ribonucleoprotein (RNP) antibodies however the exact etiology of the disease is not known. MCTD is characterized by microvascular damage, along with activation of the immune system leading to inflammation and excessive deposition of collagen in the skin, lungs, heart, gastrointestinal tract and kidneys. The females are more affected, especially after childbirth may be because of the hypothesis of microchimerism. The pathogenesis being a two way migration of fetal cells through the placenta. Although it cannot be cured completely but treatment with corticosteroids is helpful. The complications were preeclampsia, preterm labor, fetal growth restriction, eclampsia, thrombocytopenia and infections like pneumonia, sepsis like syndrome. The maternal mortality rate is approximately around 325/100000. We encountered a similar case of mixed connective tissue disorder in a patient aged 24 years at 29 weeks of gestation. The patient had conceived spontaneously after 5 yrs of diagnosis and had presented with all the known complications of the disease including lung fibrosis, FGR, preeclampsia and ascites. However she delivered and thereafter stabilized, although her baby had to be treated for a prolonged period at the NICU.

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