Epidural steroid following discectomy for herniated lumbar disc reduces neurological impairment and enhances recovery: a randomized study with two-year follow-up.

Abstract

STUDY DESIGN:

We randomized 200 patients after lumbar discectomy to receive epidural steroid or none with a 2-year follow-up.

OBJECTIVE:

To evaluate the outcome, neurologic impairment and safety of epidural steroid following lumbar discectomy for herniated disc disease.

SUMMARY OF BACKGROUND DATA:

Convalescence after discectomy for herniated disc disease is dependent on pain and the inflammatory response. Previous studies in arthroscopic and abdominal surgery demonstrate steroids, which reduce the inflammatory response and enhance recovery. Here we report a 2-year follow-up of a randomized trial of epidural steroid following lumbar discectomy.

METHODS:

Through 2001 and 2003 200 patients undergoing discectomy for herniated disc disease were randomly allocated to receive epidural methylprednisolone 40 mg or none. In the control group (62 males and 38 females, median age 41 years, 18-66) 48 L5, 50 L4, and 6 L3 discectomies were performed and in the intervention group (60 males and 40 females, median age 45 years, 15-53) 56 L5, 46 L4, and 3 L3 discectomies. Contemporary with randomization to epidural steroid or none both groups received preoperative prophylactic antibiotics and the same multimodal pain treatment.

RESULTS:

Hospital stay was reduced from 8 to 6 days (P = 0.0001) and the number of patients with neurologic signs were reduced more (70% vs. 44%, P = 0.0004) by epidural steroid. Incidence of reoperation at 1 year was 6% in both groups and 8% in the control group and 7% in the intervention group after 2 years. No infections were registered.

CONCLUSION:

Epidural methylprednisolone enhances recovery after discectomy for herniated disc disease without apparent side effects.

• Authors: Sten Rasmussen, David Stonor Krum-Møller, Lene Risbro Lauridsen, Søren Erik Holst Jensen, Hans Mandøe, Christian Gerlif, Henrik Kehlet
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 33 Issue 19 Pg. 2028-33 (Sep 01 2008) ISSN: 1528-1159 [Electronic] United States
• PMID: 18758356 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Neuroprotective Agents
• Methylprednisolone

Topics

• Adolescent
• Adult
• Aged
• Combined Modality Therapy
• Disability Evaluation
• Diskectomy
• Female
• Humans
• Injections, Epidural
• Intervertebral Disc Displacement (drug therapy, surgery)
• Length of Stay (statistics & numerical data)
• Male
• Methylprednisolone (therapeutic use)
• Middle Aged
• Neurologic Examination
• Neuroprotective Agents (therapeutic use)
• Postoperative Complications (prevention & control)
• Recovery of Function
• Reoperation (statistics & numerical data)
• Treatment Outcome