Use of epidural steroids after discectomy may predispose to infection.
METHODS
This is a report of three cases of epidural abscess occurring after use of intraoperative epidural methylprednisolone in 31 patients who had undergone lumbar microdiscectomy. The possible role of epidural steroids in the cause of these abscesses is discussed, and a review the literature concerning its value is provided.


OBJECTIVE
To evaluate experiences with the efficacy and safety of perioperative methylprednisolone.


BACKGROUND
No previous study has described a high infection rate with the use of epidural methylprednisolone. The literature supporting epidural steroids is equivocal, and reports supporting their perioperative use are scant.


METHODS
In an 8-month period, 31 patients received 1 mL (40 mg) epidural methylprednisolone at the conclusion of microdiscectomy. Therapy was discontinued after an increased postoperative deep infection rate was noted. Results in these patients were compared with those in more than 400 others who did not receive intraoperative steroids during a 7-year period.


RESULTS
In the steroid group, three epidural abscesses were encountered. There were no deep infections in the nonsteroid group.


CONCLUSIONS
The use of perioperative epidural methylprednisolone in the currently reported cases was associated with three incidences of infection. A prospective study is needed to examine its use.
Lowell
T D
TD
Florida Joint Replacement Center, New Port Richey, USA.
Errico
T J
TJ
Eskenazi
M S
MS
D000328:Adult; D001424:Bacterial Infections / Q000209:etiology*; D006801:Humans; D007268:Injections, Epidural; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*
D013256:Steroids