The epidural steroids in the prevention of epidural fibrosis: MRI and clinical findings.
BACKGROUND
Epidural fibrosis (EF) represents a frequent and poorly manageable complication of lumbar disk surgery.


OBJECTIVE
To investigate the influence of perioperative Epidural Steroid (ES) application on the development of EF.


METHODS
One hundred and seventy eight patients underwent L4/5 or L5/S1 discectomy. The study group receiving ES comprised of eighty five patients, and a further control group comprising eighty two patients received a placebo. At a 12 month follow-up, all subjects underwent contrast magnet resonance imaging of the lumbosacral spine. One hundred and sixty seven patients filled in a predetermined questionnaire containing the Visual Analogue Scale (VAS; pain scale) during the first postoperative days and 12 months after. Intergroup differences were analysed and a correlation between the extent of EF and VAS was examined.


RESULTS
The groups did not differ regarding the extent of EF. There was a statistically significant correlation between the degree of fibrosis and VAS (P<0.05). However, there was no significant difference in subjective pain assessment between both groups 12 months postoperatively. The application of ES did not influence their return to work. Patients receiving ES experienced less pain on the first and third days after surgery. The average hospital stay after surgery was shorter in the steroid treated group (4.5 days) compared to 5.2 days in the control group (p<0.05).


CONCLUSIONS
The application of ES did not prove to be useful in the prevention of Failed Back Surgery Syndrome and epidural scar formation. Postoperative pain was decreased in the steroid treated group during the first postoperative week, but not 12 months postoperatively.
Häckel
Martin
M
Department of Neurosurgery, 1st Medical Faculty, Charles University, Central Military Hospital, Czech Republic.
Masopust
Václav
V
Bojar
Martin
M
Ghaly
Youssef
Y
Horínek
Daniel
D
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D017586:Diskectomy / Q000009:adverse effects / Q000534:rehabilitation; D004824:Epidural Space / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000188:drug therapy / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010919:Placebos; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011859:Radiography; D013122:Spinal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control*; D013256:Steroids / Q000008:administration & dosage*; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D010919:Placebos; D013256:Steroids; D008775:Methylprednisolone