title: The epidural steroids in the prevention of epidural fibrosis: MRI and clinical findings.
abstract: 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.
authors.affiliation: Department of Neurosurgery, 1st Medical Faculty, Charles University, Central Military Hospital, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Häckel
authors.forename: Václav
authors.initials: V
authors.lastname: Masopust
authors.forename: Martin
authors.initials: M
authors.lastname: Bojar
authors.forename: Youssef
authors.initials: Y
authors.lastname: Ghaly
authors.forename: Daniel
authors.initials: D
authors.lastname: Horínek
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D010919:Placebos; D013256:Steroids; D008775:Methylprednisolone