The effect of perioperative corticosteroids on the outcome of microscopic lumbar disc surgery

Lundin, Anders; Magnuson, Anders; Axelsson, Kjell; Kogler, Heinz; Samuelsson, Lars

doi:10.1007/s00586-003-0554-7

Cited by 56 publications

(56 citation statements)

References 38 publications

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“…7 Fourteen of the trials commented on postoperative hospital stay and 7 found a significant reduction in the steroid group. 2,7,11,12,25,29,32 There are several limitations to this study. Most papers reviewed were not designed to analyze complications; therefore, the details of the patients who experienced complications were sometimes not available.…”

Section: Discussionmentioning

confidence: 98%

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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Section: Discussionmentioning

confidence: 98%

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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“…Several other reports also suggested the efficacy of local or systemic steroids in the immediate postoperative period. In various studies [6,9,13,14], saline or salinesoaked fat graft or absorbable gel was used in the control group and the effects were recorded. However in clinical practice we never inject saline or saline-soaked fat graft or Gelfoam if we do not intend to apply a local steroid or other agents.…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative use of corticosteroids and bupivacaine [6][7][8][9]14] has been reported as effective analgesia and decreases opioid or analgesic use without complications. Local or systematic use of various steroids [1,13] is described in the literature in lumbar disc patients. Wound infiltration with an anaesthetic agent [9,14] before the skin incision is also a way of reducing postoperative back pain.…”

Section: Introductionmentioning

confidence: 99%

“…All the modalities aim at mobilising the patient early and reducing the disability. However, use of these methods in high doses predispose to the risk of postoperative infections [12,13]. In addition, the studies describe the success of local steroid application after surgery use in a control group that had received an application of collagen foam or fat graft soaked in saline.…”

Section: Introductionmentioning

confidence: 99%

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Local application of low-dose Depo-Medrol is effective in reducing immediate postoperative back pain

Modi

Chung

Yoon

et al. 2008

International Orthopaedics (SICOT)

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This prospective, randomised case-control study was made to determine effectiveness of low-dose DepoMedrol applied to the affected nerve root after discectomy. Fifty seven patients with L4-5 or L5-S1 single level disc herniation with unilateral leg pain were selected for the study and were divided in two groups. Twenty eight patients were in the control group and 29 in the steroid group. Discectomy was done after flavotomy in all patients. In the steroid group low-dose 40 mg Depo-Medrol soaked Gelfoam was applied over the affected nerve root after discectomy while in the control group neither saline nor plain Gelfoam was applied to affected root. Postoperatively, patients were asked to evaluate backache using VAS which was compared statistically using the unpaired t test. Statistical difference was significant (p<0.0001) regarding postoperative VAS during the first month and then it became insignificant. Results show that local application of low-dose Depo-Medrol is helpful in reducing immediate postoperative backache after discectomy, but it is not effective in the long-term.Résumé Il s'agit d'une étude prospective randomisée pour montrer les effets de petite dose de dépo-Médrol appliqué sur les racines nerveuses après discectomie. 57 patients présentant une hernie discale L4-L5 ou L5-S1, avec une douleur unilatérale ont été sélectionnés pour cette étude. Deux groupes ont été constitués, 28 patients constituant le groupe contrôle et 29 patients le groupe stéroïde. La discectomie a été réalisée après l'ablation du ligament jaune chez tous les patients. Dans le groupe stéroïde une petite dose de 40 mg de Dépo-Médrol sous forme de gel a été appliquée sur la racine nerveuse après discectomie et sur le groupe contrôle un gel d'origine saline. En postopératoire les patients ont été questionnés pour évaluer les lombalgies en utilisant la méthode VAS avec tests statistiques. Les résultats sont statistiquement différents en postopératoire (p<0,0001), au cours du premier mois puis petit à petit la différence devient non significative. Ces résultats montrent donc que l'application locale d'une petite dose de dépo-médrol permet de diminuer la douleur post-opératoire immédiate après discectomie. Mais ceci n'entraîne pas d'amélioration à long terme.

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“…Six RCTs 66,73,78,84,89,106 compared surgery with intraoperative interventions and found no overall significant difference between treatment groups. Two studies 78,84 included patients with either chronic or acute sciatica and one 66 included patients who had had sciatica for longer than 3 months; the chronicity of sciatica was not reported in three studies.…”

Section: Pain Intensity At Short-term Follow-upmentioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

Lewis

Williams²,

Matar³

et al. 2011

Health Technol Assess

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The effect of perioperative corticosteroids on the outcome of microscopic lumbar disc surgery

Cited by 56 publications

References 38 publications

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

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

Local application of low-dose Depo-Medrol is effective in reducing immediate postoperative back pain

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

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