title: Effect of epidural methylprednisolone on post-operative pain and length of hospital stay in patients undergoing lumbar microdiscectomy.
abstract: OBJECTIVE
  Intraoperative epidural corticosteroids have been used to decrease post-operative pain post-discectomy. The objective of this study is to assess the efficacy of epidural corticosteroids on post-operative pain and length of post-operative hospital stay in patients undergoing unilateral lumbar microdiscectomy.
  
  
  METHODS
  150 consecutively treated, comparable patients with unilateral lumbar disc herniation were prospectively allocated randomly to receive either a sponge soaked in epidural corticosteroids or saline at the end of the operative procedure. The intensity of spontaneous pain was quantified by using the Oswestry low back pain index pre-operatively, at discharge, at week 1 follow-up and at 1st month of follow up. At the same intervals, each patient underwent the passive straight leg-raising test (PSLRT) and Visual Analogue Scale (VAS) testing. The duration of hospital stay, time taken to return to daily life activities and quantity of analgesia consumed post-operatively were also recorded.
  
  
  RESULTS
  The mean hospital stay was 1.3 ± 0.9 days in the corticosteroids group (group 1) compared to 3.2 ± 1.2 in the control group (group 2). The mean interval until return to daily life activities was 6.7 ± 2.1 days in group 1 versus 9.6 ± 4.1 days in group 2. No statistically significant difference was measured between the steroid-treated and control groups when the data were stratified for sex, age, and site of disc herniation. Differences in the OLBI scores were statistically significant at all post-operative intervals. At baseline (preoperatively), group 1 (DepoMedrol™ group) had an average score of 72.3% (±2.6%) compared to 74.6% (±3.1%) in group 2 (Control group) (P = 0.45). At discharge, OLBI scores declined to 49.7% (±4.5%) in group 1 compared to 63.5% (±3.9%) in group 2 (P = 0.034). At week 1 follow-up, OLBI scores further declined to 41.3% (±2.9%) in group 1 versus 54.2% (±5.3%) in group 2 (P = 0.014). After one month of follow-up, OLBI scores were 34.1% (±6.7%) in group 1 and 42.6% (±4.1%) in group 2 (P = 0.004). Results of VAS and PSLRT are also documented in the manuscript. The mean postoperative analgesic medications consumed was 15.6 ± 1.9 mg of morphine equivalent in the corticosteroid group versus 10.3 ± 1.8 mg of morphine equivalent in the control group. No complications of treatment occurred in either groups.
  
  
  CONCLUSIONS
  Intraoperative application of epidural corticosteroids, Depomedrol, significantly reduces post-operative pain, length of post-operative stay and duration to return to daily living activities following lumbar discectomy.
authors.affiliation: Department of Neurosurgery, Tawam Hospital in affiliation with Johns Hopkins Medical, Al-Ain, United Arab Emirates; Department of Orthopaedics, Beaumont Hospital, Dublin, Ireland. Electronic address: Yasseraljabi@rcsi.ie.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Aljabi
authors.affiliation: Department of Neurosurgery, Tawam Hospital in affiliation with Johns Hopkins Medical, Al-Ain, United Arab Emirates.
authors.forename: Amr
authors.initials: A
authors.lastname: El-Shawarby
authors.affiliation: Department of Orthopaedics, Beaumont Hospital, Dublin, Ireland.
authors.forename: Derek T
authors.initials: DT
authors.lastname: Cawley
authors.affiliation: Department of Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Aherne
mesh_terms: D000293:Adolescent; D000328:Adult; D017586:Diskectomy / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007902:Length of Stay / Q000639:trends; D008159:Lumbar Vertebrae; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: Discectomy; Epidural; Lumbar; Methylprednisolone