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


BACKGROUND
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.


CONCLUSIONS
Epidural methylprednisolone enhances recovery after discectomy for herniated disc disease without apparent side effects.
Rasmussen
Sten
S
Department of Orthopedic Surgery, Vejle and Give Hospital, Denmark. sten.rasmussen@dadlnet.dk
Krum-Møller
David Stonor
DS
Lauridsen
Lene Risbro
LR
Jensen
Søren Erik Holst
SE
Mandøe
Hans
H
Gerlif
Christian
C
Kehlet
Henrik
H