Epidural Steroids After a Percutaneous Endoscopic Lumbar Discectomy

Shin, Sang-Ha; Hwang, Byeong-Wook; Keum, Han-Joong; Lee, Sang-Jin; Park, Sang-Joon; Lee, Sang-Ho

doi:10.1097/brs.0000000000000990

Cited by 40 publications

(34 citation statements)

References 32 publications

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“…The 7 RTCs that tested therapies administered in the postoperative period included systemic pharmacological therapies (2 studies), local delivery (4 studies), and electrical stimulation (1 study) (see Table ).…”

Section: Resultsmentioning

confidence: 99%

“…In the 4 RCTs that evaluated the role of locally administered drugs to prevent and treat postoperative pain after lumbar spine procedures, Singh et al proved the superiority of continuous wound infiltration of 0.25% levobupivacaine compared to continuous epidural infusion of 0.25% levobupivacaine and PCA of 1 mg morphine; either epidural steroids, after percutaneous endoscopic lumbar discectomy, or levobupivacaine combined with tramadol, after lumbar spine surgery, proved to be effective in reducing postoperative pain; and controversial results were obtained with postoperative administration of bupivacaine …”

Section: Resultsmentioning

confidence: 99%

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Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

et al. 2018

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Clinical evidence on perioperative pain management in patients undergoing spine procedures have significantly evolved after the review published in 2012. The aim of this systematic review was to report the latest evidence published. These include the preoperative use of dexamethasone, which was shown to be able to reduce pain at mobilization but not to reduce pain at rest or total morphine consumption; the use of gabapentinoids as part of a multimodal analgesic approach; and the safety and effectiveness of the intraoperative use of ketamine, dexketoprofen, and tramadol. Finally, electrical nerve stimulation is gaining interest and is potentially suitable for clinical needs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

et al. 2018

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“…Only one study has investigated the effects of epidural steroids after PELD before this study. Their randomized controlled study concluded that epidural steroids after PELD improved clinical effect and functional outcomes in the short-term surgery 13 . And a large number of samples and randomized controlled studies made the conclusion more convincing.…”

Section: Discussionmentioning

confidence: 98%

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

Yang

Zeng

et al. 2017

Chinese Journal of Traumatology

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ObjectiveTo assess the early curative effect of epidural or intravenous administration of steroids during a percutaneous endoscopic lumbar discectomy (PELD).Methods28 consecutive patients who underwent PELD due to large lumbar disc herniation between November 2014 and January 2016 were followed up for 6 months. These patients were divided into two groups according to the treatment they received after PELD. 14 patients (Group A) were treated by PELD and epidural steroids, while the other 14 patients (Group B) were treated by PELD and intravenous steroids. We evaluated the effectiveness by the preoperative and postoperative visual analogue scale (VAS) scores for back and leg pain, and the postoperative Oswestry disability index (ODI) at 3 weeks after surgery via the clinical charts and telephone interview. Postoperative hospital stay and time return to work were investigated as well.ResultsThere is a significant decrease in VAS (back, leg), ODI, and time return to work (p < 0.05). For VAS (back), Group A showed a significant decrease compared with Group B at 1 day and 1 week after surgery (p = 0.011, p = 0.017). As for VAS (leg), Group A showed a significant decrease compared with Group B at 1 day, 1 week, 3 weeks, and 3 months follow-up examinations (p = 0.002, p = 0.006, p < 0.001, p < 0.001). For ODI, Group A showed a notable decrease compared with Group B (p < 0.001). The postoperative hospital stay in two groups was not statistically different (p = 0.636). But the time return to work in Group A was significantly shorter than that in Group B (p = 0.023).ConclusionPatients who underwent PELD with epidural steroid administration for large lumbar disc herniation showed favorable curative effect compared with those who underwent PELD with intravenous steroid administration.

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“…L ow-back pain (LBP) and irradiating leg pain secondary to lumbar disc herniation (LDH) are generally thought to result from both mechanical pressure on the nerve roots and inflammatory response. 35,46 While surgical removal of the herniated nucleus pulposus is effective in alleviating local pressure, the inflammatory mediators remain for days to weeks after the procedure. 9 As a result of this, poorly controlled postoperative pain delays mobilization and the start of physiotherapy, thereby prolonging hospitalization and diminishing hope for recovery.…”

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confidence: 99%

“…With the ongoing development and validation of reliable generic and disease-specific measures of pain, functional impairment, and health-related quality of life (hrQoL), the effect of ES application during lumbar spine surgery has been reinvestigated. 3,[25][26][27]32,34,37,43,44,46 In a recent systematic review, evidence suggested that intraoperative ES application is effective in reducing pain in the early period up to 2 weeks postoperatively, whereas the effectiveness in the intermediate (2 weeks to 2 months) and longer term (> 2 months) was rather weak. 26 In these studies, subjective measures of disability were used, as standardized objective measures of function have been introduced only recently.…”

mentioning

confidence: 99%

Efficacy of intraoperative epidural triamcinolone application in lumbar microdiscectomy: a matched-control study

Stienen

Joswig

Chau

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEThe purpose of this study was to investigate whether the intraoperative application of an epidural steroid (ES) on the decompressed nerve root improves short- and midterm subjective and objective clinical outcomes after lumbar microdiscectomy.METHODSThis study was a retrospective analysis of a 2-center database including consecutive cases in which patients underwent lumbar microdiscectomy. All patients who received ES application (40 mg triamcinolone, ES group) were matched by age and sex to patients who had not received ES application (control group). Objective functional impairment (OFI) was determined using age- and sex-adjusted T-scores of the Timed Up and Go (TUG) test. Back and leg pain (visual analog scale), functional impairment (Oswestry Disability Index [ODI], Roland-Morris Disability Index [RMDI], and health-related quality of life (hrQoL; 12-Item Short Form Health Survey [SF-12] physical component summary [PSC] score and EuroQol [EQ-5D index]) were measured at baseline, on postoperative day 3, and at postoperative week 6.RESULTSFifty-three patients who received ES application were matched with 101 controls. There were no baseline demographic or disease-specific differences between the study groups, and preoperative pain, functional impairment, and hrQoL were similar. On postoperative day 3, the ES group had less disability on the RMDI (mean 7.4 vs 10.3, p = 0.003) and higher hrQoL as determined by the SF-12 PCS (36.5 vs 32.7, p = 0.004). At week 6, the ES group had less disability on the RMDI (3.6 vs 5.7, p = 0.050) and on the ODI by trend (17.0 vs 24.4, p = 0.056); better hrQoL, determined by the SF-12 PCS (44.3 vs 39.9, p = 0.018); and lower OFI (TUG test T-score 100.5 vs 110.2, p = 0.005). The week 6 responder status based on the minimum clinically important difference (MCID) was similar in the ES and control groups for each metric. The rates and severity of complications were similar, with a 3.8% and 4.0% reoperation rate in the ES group and control group, respectively (p = 0.272). There was a tendency for shorter hospitalization in the ES group (5.0 vs 5.8 days, p = 0.066).CONCLUSIONSIntraoperative ES application on the decompressed nerve root is an effective adjunct treatment that may lower subjective and objective functional impairment and increase hrQoL in the short and intermediate term after lumbar microdiscectomy. However, group differences were lower than the commonly accepted MCIDs for each metric, indicating that the effect size of the benefit is limited.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: retrospective cohort trial; evidence: Class II.

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Epidural Steroids After a Percutaneous Endoscopic Lumbar Discectomy

Abstract: 2.

Cited by 40 publications

References 32 publications

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

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

Efficacy of intraoperative epidural triamcinolone application in lumbar microdiscectomy: a matched-control study

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