Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease

Ranguis, Sebastian; Li, Dianna; Webster, Angela C

doi:10.3171/2010.6.spine09796

Cited by 47 publications

(53 citation statements)

References 45 publications

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“…The review by Ranguis et al . in 2010 missed several key trials[15] and did not distinguish microdiscectomy from laminectomy, which are two different procedures. It also did not analyze steroids administered intravenously or in oral form.…”

Section: Discussionmentioning

confidence: 99%

Perioperative steroids for lumbar disc surgery: A meta-analysis of randomized controlled trials

Waqas¹,

Shallwani²,

Shamim³

et al. 2017

Surg Neurol Int

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Background:Our review question was “Does perioperative steroids administration, in comparison with other treatments or placebo, improve either postoperative pain control, length of hospital stay, or return to work in patients undergoing lumbar disc surgery?”Methods:We searched PubMed, CINAHL PLUS, and Cochrane databases for randomized control trials (RCTs) studying the role of steroids for lumbar disc surgery. Studies that compared perioperative steroids with other treatments or placebo were included. Study outcomes included postoperative back pain, leg pain, length of hospital stay, and return to work. Data was extracted through a proforma. Means and mean differences were calculated for continuous data, whereas odds ratios were calculated for dichotomous data. Data were analyzed with the help of Rev Man 5.Results:Twenty RCTs were included in the review. Quantitative analysis could be performed on 19 RCTs. Intraoperative steroids improve control of back pain at 24–48 hours. Although there was some benefit of steroid administration in controlling postoperative leg pain, it disappeared at 1 year and in the overall pooled analysis. The length of hospital stay was much shorter in the steroid group. The frequency of adverse events and complications also favored steroid administration.Conclusion:Intraoperative epidural steroid administration offers some benefit in pain control with a significant reduction in the length of hospital stay. However, there is insufficient evidence to support the routine use of oral and intravenous steroids in the perioperative period.

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Section: Discussionmentioning

confidence: 99%

Perioperative steroids for lumbar disc surgery: A meta-analysis of randomized controlled trials

Waqas¹,

Shallwani²,

Shamim³

et al. 2017

Surg Neurol Int

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“…9,10 The benefits of corticosteroid use in the neurosurgical population are numerous and well known; they have been shown to decrease perioperative swelling, minimize inflammation, and improve functional outcomes following spinal cord compression. [11][12][13][14][15] Neurosurgical procedures therefore are often performed in the setting of corticosteroid use because of their desired favorable effects; however, the risks of infections following preoperative steroid use are less well defined.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Steroid Use and the Risk of Infectious Complications After Neurosurgery

Merkler

Saini

Kamel

et al. 2013

The Neurohospitalist

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Background and Purpose: The association between preoperative corticosteroid use and infectious complications after neurosurgical procedures is unclear. We aim to determine whether corticosteroids increase the risk of infectious complications after neurosurgery. Methods: We examined the association between preoperative corticosteroid use and postoperative infectious complications in a cohort of adults who underwent a neurosurgical procedure between 2005 and 2010 at centers participating in the National Surgical Quality Improvement Program. Corticosteroid use was defined as at least 10 days of oral or parental therapy in the 30 days prior to surgery. Our primary outcome was a composite of any infectious complications occurring within 30 days of surgery. We used propensity score analysis to examine the independent association between preoperative corticosteroid use and postoperative infections. Results: Among 26 634 neurosurgical procedures, 1228 (4.61%, 95% confidence interval [CI], 4.36-4.86) were preceded by preoperative corticosteroid use and 1469 (5.52%; 95% CI, 5.24-5.79) were followed by postoperative infections. In a propensity score analysis controlling for comorbidities, illness severity, and preexisting preoperative infections, corticosteroid use was independently associated with subsequent postoperative infections (odds ratio, 1.38; 95% CI, 1.11-1.70). Our results were unchanged in sensitivity analyses controlling for central nervous system tumors or active treatment with chemotherapy. Conclusion: Our results suggest that preoperative corticosteroid use is associated with an increased risk of infectious complications after neurosurgery. These findings may aid physicians with preoperative treatment decisions and risk stratification. Future randomized trials are needed to guide preoperative use of corticosteroids in this population.

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“…16,31 Neither directly addressed surgical complications. In 2010, Ranguis et al published a systematic review of 12 trials published between 1992 and 2008 that examined whether epidural steroid usage after lumbar discectomy led to a decrease in postoperative pain.…”

mentioning

confidence: 99%

“…In 2010, Ranguis et al published a systematic review of 12 trials published between 1992 and 2008 that examined whether epidural steroid usage after lumbar discectomy led to a decrease in postoperative pain. 31 In 2014, Jamjoom and Jamjoom published a review that added trials published between 2009 and 2012. 16 Since 2012 there has been 1 additional prospective randomized trial discussing epidural steroid use.…”

mentioning

confidence: 99%

Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis

Akinduro

Miller²,

Haussen

et al. 2015

FOC

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OBJECT The authors’ aim in this paper was to review the intraoperative use of epidural steroids in lumbar discectomy surgery with a focus on surgical complications. METHODS A comprehensive literature search was done using PubMed, MEDLINE, and the Cochrane Central Registry of Controlled Trials. Relevant papers were retrieved and analyzed. The authors performed a meta-analysis of all available data. Search terms included epidural, steroids, discectomy, lumbar disc surgery, herniated lumbar disc, methylprednisolone, and perioperative.The primary outcome was surgical complications such as wound infection or need for reoperation. Secondary outcomes were pain and postoperative narcotic usage. RESULTS Sixteen trials and 1 retrospective study (a total of 1933 patients) were eligible for inclusion in this study. In all studies, steroids were added epidurally over the nerve root before closure in cases, and control patients underwent discectomy alone. The mean age (42.7 years vs 42.4 years; RR 0.30 [95% CI −0.30 to 0.90], p = 0.32), overall complication rates (2.69% vs 1.18%; RR 1.94 [95% CI 0.72–5.26], p = 0.19), and infectious complication rates (0.94% vs 0.08%; RR 4.58 [95% CI 0.75–27.95], p = 0.10) were similar between the steroid group and control group, respectively. CONCLUSIONS There is good evidence that epidural steroids can decrease pain in the short term and decrease the usage of postoperative narcotics after lumbar spinal surgery for degenerative spinal disease. The authors’ results demonstrate a trend toward increased infection with epidural steroid use, but there was not a statistically significant difference. More studies are needed to validate the long-term risk/benefit ratio of epidural steroids in lumbar discectomy.

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Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease

Cited by 47 publications

References 45 publications

Perioperative steroids for lumbar disc surgery: A meta-analysis of randomized controlled trials

Perioperative steroids for lumbar disc surgery: A meta-analysis of randomized controlled trials

Preoperative Steroid Use and the Risk of Infectious Complications After Neurosurgery

Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis

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