Lumbar discectomy in post epidural steroid treated patients for disc prolapse

Abstract

In spine surgery, it is common practice to thoroughly exhaust all conservative measures before surgery. With the increasing popularity of injection procedures, significant number may still require surgery post epidural steroid infiltration (ESI). We aim to study the incidence of such patients who eventually go in for surgery after a failed ESI. We also studied and compared the functional outcomes of transforaminal (TF) versus interlaminar (IL) procedures in intervertebral disc prolapse (IVDP) patients. Materials and Methods: 150 patients with lumbar disc prolapsed were subjected to epidural steroid infiltration after 6 weeks of failed conservative management, of which 101 underwent IL and 49 TF procedure according to surgeon's preference, and followed up for 6 weeks. Those with persisting (or worsening) Visual analogue scale (VAS), Modified Oswestry diability index (ODI) and with progressive neurological deficits, underwent lumbar discectomy and all were followed up for 6 months. Results: Out of 150 patients, 45 patients underwent discectomy (30 %) after total 6 months follow up, and out of the remaining 105 patients, 40 (81.6%) from TF group and 65 (64.4%) from IL group improved. In total, 62% of females went to surgery, Minimal disability in ODI score was seen in 77.8% in surgery group and 98.1% in epidural group at final follow up. Conclusion:Our study observed a much smaller crossover rate (30%) to surgery, and a significant difference in outcomes of the two injection methods and concludes that TF is a better procedure than IL.