A retrospective study of epidural and intravenous steroids after percutaneous endoscopic lumbar discectomy for large lumbar disc herniation

Yang, Zhiying; Yang, Xinjian; Zeng, Teng-Hui; Qiu, Yiyan; Wang, Yitian; Liang, Fei-Guo

doi:10.1016/j.cjtee.2016.10.003

Cited by 11 publications

(11 citation statements)

References 18 publications

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“…PELD has become a popular operative procedure for LDH. The clinical outcome has been reported for each operative approach (interlaminar, transforaminal, and posterolateral) [ 6 , 10 , 11 ]. Although previous studies have shown satisfactory clinical results of PELD in hospitalized patients with LDH, and only a few studies reported about the day surgery patients undergoing PELD.…”

Section: Discussionmentioning

confidence: 99%

Follow-up results of microendoscopic discectomy compared to day surgery using percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation

Song

Ran

Luo

et al. 2021

BMC Musculoskelet Disord

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Background Percutaneous endoscopic lumbar discectomy (PELD) is satisfactory for hospitalized patients with lumbar disc herniation (LDH). Currently, only a few studies have reported about the day surgery patients undergoing PELD. Methods A total of 267 patients with LDH underwent PELD during day surgery and were followed up for at least 3 years. Clinical outcomes were assessed using the visual analog scale (VAS) for leg and lower back pain (VAS-B and VAS-L, respectively) and the Oswestry disability index (ODI). The radiological outcomes, such as lumbar lordosis (LL), sacral slope (SS), the disc-height ratio, and disc instability, were recorded and compared. The clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized 116 patients with LDH were compared. Results Patients treated by PELD had lower blood loss and shorter hospital stay (P < 0.001) compared to those treated by MED. VAS-L, VAS-B, and ODI decreased significantly after PELD than before the operation and 3 years postoperatively. The postoperative VAS-B in the PELD group was significantly decreased than in the MED group (P = 0.001). The complications rate was 9.4% in the PELD group and 12.1% in the MED group (P = 0.471). The 1-year postoperative recurrence rate in the PELD group was much higher than that in MED group (P = 0.042). The postoperative LL and SS in the PELD group improved significantly compared to the values in the MED group (P < 0.001). According to the disc-height ratio at 3-year follow-up, a significant height loss was observed in the MED group than in the PELD group (P = 0.014). Conclusions Although the 1-year postoperative recurrence rate was relatively high, the day surgery for LDH undergoing PELD had advantages in terms of less blood loss intraoperatively, short hospital stay, efficacy for back pain, and efficiency to maintain lumbar physiological curvature.

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Section: Discussionmentioning

confidence: 99%

Follow-up results of microendoscopic discectomy compared to day surgery using percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation

Song

Ran

Luo

et al. 2021

BMC Musculoskelet Disord

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show abstract

“…PELD has become a popular operative procedure for LDH. The clinical outcome has been reported for each operative approach (interlaminar, transforaminal, and posterolateral), and satisfactory results have already been reported (6,11,12). Although numerous previous studies have shown good clinical results of PELD for hospitalized patients with LDH, there are few articles reporting on the day surgery patients undergoing PELD.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Follow-Up Results of Day Surgery for Lumbar Disc Herniation Using Percutaneous Endoscopic Lumbar Discectomy: A Single-Center Experience of 267 Cases.

Song¹,

Ran²,

Luo³

et al. 2020

Preprint

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Background: Although numerous studies have shown good clinical results of percutaneous endoscopic lumbar discectomy (PELD) for hospitalized patients with lumbar disc herniation (LDH), there are few articles that report on the day surgery patients undergoing PELD.Methods: Atotal of 267 patients with LDH received PELD during day surgery were followed up for at least 3 years. Relevant data and clinical outcomeswere recorded and assessed. Meanwhile, we compared the clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized patients with LDH (116 patients).Results: Patients treated by PELD had lower blood loss (10.8 ± 4.1 mL, 71.3 ± 23.3 mL,respectively; P < 0.001) and shorter hospital stay ( 22.7 ± 4.2 hours, 48.1 ± 22.6 hours, respectively; P < 0.001 ) compared with patients treated by MED. The visual analogue scale (VAS) for leg and back pain (VAS-L and VAS-B, respectively) and Oswestry disability index (ODI) decreased significantly after PELD than those before the operation at 3 years postoperative, and the postoperative VAS-B in PELD group was significantly decreased from the MED group ( P = 0.001). The complications rate was 9.4% (25/267) in the PELD group and 12.1% (14/116) in the MED group, without significant difference ( P = 0.471). The 1-year postoperative recurrence rate in PELD group ( 5.2%, 14/267) was much higher than that in MED group ( 0.9%, 1/116) ( P = 0.042). The postoperative lumbar lordosis（LL）(34.0 ±10.3 ), and sacral slope（SS) (27.5 ± 5.6) in PELD group improved significantly compared with the values in MED group (26.9 ± 9.8, 23.6 ± 6.8, respectively; all P < 0.001). The disc-height ratio at 3-year follow-up was ( 85.7 ± 6.4) % of the preoperative disc height in PELD group while ( 81.9 ± 7.0) % in MED group，with significant height loss in MED group ( P = 0.014).Conclusions: Day surgery for LDH undergoing PELD has favorable long-term outcomes.

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“…Compared with other studies (21,22), in which a similar minimally invasive PELD was performed, the medication method was different. The therapeutic efficacy of "cocktail treatment" should be better than that of single steroid usage; the drugs are delivered through the gelatin sponges, which can exert a more targeted effect on the nerves, raising the local drug concentration and prolonging the action time.…”

Section: E215mentioning

confidence: 95%

“…In consideration of the half-life period of steroids, dexamethasone, a long-acting steroid with a half-life period of approximately 36-54 hours, was selected. Zhang et al (21) proved that patients who underwent PELD with epidural steroid administration for large LDH showed favorable curative effect compared www.painphysicianjournal.com with those who underwent PELD with intravenous steroid administration. In another randomized study, Shin et al (22) observed that epidural steroids after PELD reduced back pain and leg pain while improving functional outcomes in the short-term postsurgical period.…”

Section: E215mentioning

confidence: 99%

Cocktail Treatment with a Gelatin Sponge Impregnated with Ropivacaine, Dexamethasone, and Vitamin B12 Promotes Early Postoperative Recovery after Percutaneous Endoscopic Lumbar Discectomy: A Retrospective, Case-Controlled Study

Yang¹,

Liu

Chu

et al. 2020

Pain Phys

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Background: Percutaneous endoscopic lumbar discectomy (PELD) can only relieve mechanical compression but cannot directly reduce the inflammatory reaction of the adjacent nerve root, which contributes to persistent pain and physical disabilities postoperatively. Numerous studies have explored the application of epidural steroids after an open lumbar discectomy in relieving pain by reducing local inflammatory reactions and further peridural scar formation. Objectives: To explore that whether “cocktail treatment” in which a gelatin sponge was impregnated with ropivacaine, dexamethasone, and vitamin B12 promoted early postoperative recovery after PELD. Study Design: Retrospective, case-controlled study. Setting: All data were from Hong-Hui Hospital in Xi’an. Methods: Between January 2016 and January 2017, 100 patients of single-level lumbar disc herniation were treated with PELD in our hospitals. The cocktail treatment was applied in the first 50 patients (group cocktail), and an equal size gelatin sponge without drugs was used in the other 50 patients as control (group noncocktail). The clinical outcome evaluation included the Visual Analog Scale (VAS) score for back and leg pain and Oswestry Disability Index (ODI) score. Results: There was a significant difference in the mean periods of return to work (4.25 ± 1.88 weeks in the cocktail group and 5.18 ± 2.19 weeks in the noncocktail group) (P < 0.01). Compared with the preoperative data, a significant improvement in VAS scores of back pain and sciatica and ODI were observed in each follow-up interval (P < 0.05, respectively). In the noncocktail group, there were visible fluctuations in the 3 indicators within the first week after surgery. This phenomenon was not observed in the cocktail group, a difference that was statistically significant (P < 0.05, respectively). In further follow-up, no significant differences were observed between the 2 groups (P > 0.05, respectively). Limitations: The nonrandomized, single-center, retrospective design is a major limitation of this study. Conclusions: The “cocktail treatment” with a gelatin sponge impregnated with ropivacaine, dexamethasone, and vitamin B12 promotes early and satisfactory back and leg pain relief and fast functional recovery after PELD. Key words: Endoscopic lumbar discectomy, lumbar disc herniation, steroids, nerve root block, gelatin sponge

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A retrospective study of epidural and intravenous steroids after percutaneous endoscopic lumbar discectomy for large lumbar disc herniation

Cited by 11 publications

References 18 publications

Follow-up results of microendoscopic discectomy compared to day surgery using percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation

Follow-up results of microendoscopic discectomy compared to day surgery using percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation

Long-Term Follow-Up Results of Day Surgery for Lumbar Disc Herniation Using Percutaneous Endoscopic Lumbar Discectomy: A Single-Center Experience of 267 Cases.

Cocktail Treatment with a Gelatin Sponge Impregnated with Ropivacaine, Dexamethasone, and Vitamin B12 Promotes Early Postoperative Recovery after Percutaneous Endoscopic Lumbar Discectomy: A Retrospective, Case-Controlled Study

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