The effect of perioperative corticosteroids on the outcome of microscopic lumbar disc surgery

Abstract

Eighty adult patients with lumbar disc herniation verified by magnetic resonance imaging (MRI) and clinical findings corresponding to the radiological level underwent microscopic disc removal to evaluate the outcome of perioperatively given corticosteroids in a prospective randomized double-blind study. In the treatment group the patient received 250 mg Solu-Medrol intravenously and 160 mg Depo-Medrol intramuscularly. Before closure of the wound, a free fat transplant soaked in 80 mg Depo-Medrol was placed on the dural sac. In the control group the same procedure was performed, but sodium chloride was given instead of Depo-Medrol. All patients underwent a clinical examination before surgery and at 2, 6, 12, 26, 52 and 104 weeks postoperatively, rating their pain with the visual analog scale (VAS) and function with the Disability Rating Index (DRI). The postoperative hospital stay was significantly shorter (P=0.01) in the treatment group (1.7 days) compared to the control group (2.3 days). Time taken to return to full-time work was also significantly shorter in the treatment group (P=0.003). VAS-W (Worst Pain during last week) was significantly lower in the treatment group (P=0.02). Postoperative spondylitis occurred in one patient in the control group and no adverse corticosteroids effect was seen. Our study shows that perioperatively given corticosteroids improve the outcome of microscopic disc surgery in terms of length of hospital stay and time taken to return to full-time work. The results also indicate that corticosteroid treatment reduces pain and improves functional outcome.

Fig. 1.

Cumulative percentage of 80 patients discharged from hospital after microsurgical discectomy (steroid group n=38, control group n=42)

Fig. 2.

Cumulative percentage of 80 patients returned to full-time work after microsurgical discectomy (steroid group n=37, control group n=36)

Fig. 3.

Mean values of current pain measured by visual analog scale (range 0–100) of 80 patients undergoing microsurgical discectomy (steroid group n=38, control group n=42)

Fig. 4.

Mean values of worst pain during the last week measured by visual analog scale (range 0–100) of 80 patients undergoing microsurgical discectomy (steroid group n=38, control group n=42)

Fig. 5.

Mean values of Disability Rating Index (range 0–100) of 80 patients undergoing microsurgical discectomy (steroid group n=38, control group n=42)