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Comparative outcomes of epidural steroids versus placebo after lumbar discectomy in lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials

  • Original Article • SPINE - EPIDEMIOLOGY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Treatment for lumbar disc herniation after failed conservative treatment is discectomy. Discectomy can significantly relieve back pain as well as radicular symptoms. However, many patients with lumbar discectomy experience moderate-to-severe back pain and radicular leg pain. The results of application of epidural steroids (ES) for pain management after lumbar discectomy have previously been inconclusive. We have conducted a systematic review and meta-analysis aims to compare outcomes (efficacy and complications) of epidural steroid application and placebo after discectomy in lumbar disc herniation. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies that reported visual analog scale of back and leg pain, morphine consumption, hospital stay and post-operative complications of either group were identified from Medline and Scopus from the date of inception to 28 October 2017. A total of 12 studies were pooled and analysed, with nine studies having undergone conventional discectomy and three studies having undergone minimally invasive surgery (MIS) discectomy. Overall, there were 1006 patients (502 in the ES group and 504 in the placebo group) included. The unstandardized mean difference of VAS of back pain at 1 week and 1 month, leg pain at 1 week and 1 month, morphine consumption and hospital stay was − 0.53 (95% CI − 1.42, 0.36) score, − 0.89 (95% CI − 1.36, − 0.42) score, − 0.63 (95% CI − 0.75, − 0.50) score, − 0.47 (95% CI − 0.78, − 0.15) score, − 8.47 (95% CI − 16.16, − 0.78) mg and − 0.89 (95% CI − 1.49, − 0.30) days lower when compared to placebo after lumbar discectomy in patients with lumbar disc herniation. A total of ten studies compared the ratio of complication between the ES and placebo groups. No significant differences were noted for complications within the two groups (0.92; 95% CI 0.47, 1.83). This meta-analysis analysed lower back and leg pain, morphine consumption and hospital stay, with no significant difference in complications for ES application after lumbar discectomy in lumbar disc herniation. In terms of surgical approaches with MIS compared to conventional approach, this review demonstrates that ES can reduce post-operative morphine consumption when the surgical approach is conventional, but not for MIS.

Level of evidence I.

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Acknowledgements

All authors declare no funding source or sponsor involvement in the study design, collection, analysis and interpretation of the data, in writing the manuscript and in submission of the manuscript for publication.

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Authors and Affiliations

  1. Orthopedics Department, Lerdsin General Hospital, Bangkok, Thailand

    Alisara Arirachakaran

  2. Orthopedic Department, Bangkok Memorial Administration General Hospital, Bangkok, Thailand

    Montree Siripaiboonkij

  3. Orthopedics Department, Queen Savang Vadhana Memorial Hospital, Sriracha, Cholburi, Thailand

    Saran Pairuchvej

  4. Orthopedics Department, Police General Hospital, Bangkok, Thailand

    Kittipong Setrkraising

  5. Spine Unit, Orthopedics Department, Lerdsin General Hospital, Bangkok, Thailand

    Pritsanai Pruttikul

  6. Spine Unit, Institute of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand

    Chaiwat Piyasakulkaew

  7. Section for Sport and Orthopedic Center, Samitivej Hospital, Bangkok, Thailand

    Jatupon Kongtharvonskul

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  1. Alisara Arirachakaran
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  2. Montree Siripaiboonkij
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Contributions

AA was responsible for the conception and design, collection and assembly of data, analysis and interpretation of the data, drafting of the manuscript, final approval of the article. MS was responsible for the conception and design, collection and assembly of data, critical revision of the manuscript for important intellectual content, final approval of the article. SP was responsible for manuscript writing, critical revision of the manuscript for important intellectual content, final approval of the article. KS was responsible for manuscript writing, critical revision of the manuscript for important intellectual contents, final approval of the article. PP was responsible for collection and assembly of data. CP was responsible for collection and assembly of data. JK was responsible for the conception and design, collection and assembly of data, supervise in analysis and interpretation of the data, writing the manuscript, critical revision of the manuscript for important intellectual contents, final approval of the article, statistical expertise.

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Correspondence to Jatupon Kongtharvonskul.

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Arirachakaran, A., Siripaiboonkij, M., Pairuchvej, S. et al. Comparative outcomes of epidural steroids versus placebo after lumbar discectomy in lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol 28, 1589–1599 (2018). https://doi.org/10.1007/s00590-018-2229-4

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  • DOI: https://doi.org/10.1007/s00590-018-2229-4

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