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

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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.

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References

  1. Andersson GBJ, Brown MD, Dvorak J, Herzog RJ, Kambin P, Malter A, McCulloch JA, Saal JA, Spratt KF, Weinstein JN (1996) Consensus summary on the diagnosis and treatment of lumbar disc herniation. Spine 21:75S–78S

    CAS  PubMed  Google Scholar 

  2. Bernsmann K, Krämer J, Ziozios I, Wehmeier J, Wiese M (2001) Lumbar micro disc surgery with and without autologous fat graft. Arch Orthop Trauma Surg 121:476–480

    Article  CAS  PubMed  Google Scholar 

  3. Brisby H (2000) Nerve tissue injury markers, inflammatory mechanisms and immunologic factors in lumbar disc herniation. Thesis, Gothenburg University

  4. Brisby H, Olmarker K, Larsson K, Nutu M, Rydevik B (2002) Proinflammatory cytokines in cerebrospinal fluid and serum in patients with disc herniation and sciatica. Eur Spine J 11:62–66

    Article  CAS  PubMed  Google Scholar 

  5. Buchman AL (2001) Side effects of corticosteroids therapy. J Clin Gastroenterol 33:289–293

    Article  CAS  PubMed  Google Scholar 

  6. Carette S, Lecaire R, Marcoux S, Morin F, Blaise G, St-Pierre A, Truchon R, Parent F, Lévesque J, Bergeron V, Montminy P, Blanchette C (1997) Epidural corticosteroids for sciatica due to herniated nucleus pulposus. N Engl J Med 336:1630–1640

    Article  Google Scholar 

  7. Cornefjord M, Olmarker K, Otani K, Rydevik B (2002) Nucleus pulposus-induced nerve root injury: effect of diclofenac and ketoprofen. Eur Spine J 11:57–61

    Article  CAS  PubMed  Google Scholar 

  8. Davis R, Emmons SE (1990) Benefits of epidural methylprednisolone in a unilateral lumbar discectomy: a matched controlled study. J Spinal Disord 3:299–306

    CAS  PubMed  Google Scholar 

  9. Foulkes GD, Robinson JS Jr (1989) Intraoperative dexamethasone irrigation in lumbar microdiskectomy. Clin Orthop 261:224–228

    Google Scholar 

  10. Glasser RS, Knego RS, Delashaw JB, Fessler RG (1993) The perioperative use of corticosteroids and bupivacaine in the management of lumbar disc disease. J Neurosurgery 78:383–387

    CAS  Google Scholar 

  11. Grönblad M, Virri J, Tolonen J, Seitsalo S, Kääpä E, Kankare J, Myllynen P, Karaharju E (1994) A controlled immunohistochemical study of inflammatory cells in disc herniation tissue. Spine 19:2744–2751

    CAS  PubMed  Google Scholar 

  12. Huskisson EC (1974) Measurement of pain. Lancet 7889:1127–1131

    Google Scholar 

  13. Jensen TT, Asmussen K, Berg-Hansen E-M, Lauritsen B, Manniche C, Vinterberg H, Jensen LE, Kramhøft J (1996) First-time operation for lumbar disc herniation with and without free fat transplantation. Spine 21:1072–1076

    Article  CAS  PubMed  Google Scholar 

  14. Kanamori M, Kawaguchi Y, Ohmori K, Kimura T, Tsuji H, Matsui H (2001) The fate of free-fat grafts after posterior lumbar surgery. Spine 26:2258–2263

    Article  CAS  PubMed  Google Scholar 

  15. Karppinen J, Malmivaara A, Kurunlahti M, Kyllönen E, Pienimäki T, Nieminen P, Ohinmaa A, Tervonen O, Vanharanta H (2001) Periradicular infiltration for sciatica. Spine 26:1059–1067

    Article  CAS  PubMed  Google Scholar 

  16. Kiviluoto O (1976) Use of free fat transplants to prevent epidural scar formation. Acta Orthop Scand Suppl 164:66–69

    Google Scholar 

  17. Langenskiöld A, Kviluoto O (1976) Prevention of epidural scar formation after operations on the lumbar spine by means of free fat transplants. Clin Orthop 115:92–95

    PubMed  Google Scholar 

  18. Lavyne MH, Bilsky MH (1992) Epidural steroids, postoperative morbidity, and recovery in patients undergoing microsurgical lumbar discectomy. J Neurosurgery 77:90–95

    CAS  Google Scholar 

  19. Lowell TD, Errico TJ, Eskenazi MS (2000) Use of epidural steroids after discectomy may predispose to infection. Spine 25:516–519

    Article  CAS  PubMed  Google Scholar 

  20. Manniche C, Lauritsen B, Vinterberg H (1994) Peroperative prednisolone fails to improve the clinical outcome following surgery for prolapsed lumbar intervertebral disc. Scand J Rheumatol 23:30–35

    CAS  PubMed  Google Scholar 

  21. McCarron RF, Wimpee MW, Hukins PG, Laros GS (1987) The inflammatory effect of nucleus pulposus. Spine 12:760–764

    CAS  PubMed  Google Scholar 

  22. Milligan KR, Macaffe AL, Fogarty DJ, Wallace RGH, Ramsey P (1993) Intraoperative bupivacaine diminishes pain after lumbar discectomy. J Bone Joint Surg Br 75:769–771

    CAS  PubMed  Google Scholar 

  23. Mirzai H, Tekin I, Alincak H (2002) Perioperative use of corticosteroids and bupivacaine combination in lumbar disc surgery. Spine 27:343–346

    Article  PubMed  Google Scholar 

  24. Möller H, Hedlund R (2000) Surgery versus conservative management in adult isthmic spondylolisthesis. Spine 25:1711–1715

    PubMed  Google Scholar 

  25. Naylor A, Flowers MW, Bramley JED (1977) The value of dexamethasone in the postoperative treatment of lumbar disc prolapse. Orthop Clin North Am 8:3–8

    CAS  PubMed  Google Scholar 

  26. Olmarker K, Byröd G, Cornefjord M, Nordborg C, Rydevik B (1994) Effects of methylprednisolone on nucleus pulposus-induced nerve root injury. Spine 19:1803–1808

    CAS  PubMed  Google Scholar 

  27. Olmarker K, Blomquist J, Strömberg J, Nannmark U, Thomsen P, Rydevik B (1995) Inflammatogenic properties of nucleus pulposus. Spine 20:665–669

    CAS  PubMed  Google Scholar 

  28. Ozaktay AC, Cavanaugh JM, Asik I, DeLeo JA, Weinstein JN (2002) Dorsal root sensitivity to interleukin-1 beta, interleukin-6 and tumor necrosis factor in rats. Eur Spine J 11:467–475

    Article  PubMed  Google Scholar 

  29. Piperno M, Hellio le Graverand MP, Reboul P, Mathieu P, Tron AM, Perrin G, Peschard MJ, Richard M, Vignon E (1997) Phospholipase A2 activity in herniated lumbar disc. Spine 22:2061–2065

    Article  CAS  PubMed  Google Scholar 

  30. Postacchini F (1996) Results of surgery compared with conservative management for lumbar disc herniation. Spine 21:1383–1387

    Article  CAS  PubMed  Google Scholar 

  31. Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Goldthwaite N (1990) High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine 15:674–678

    CAS  PubMed  Google Scholar 

  32. Salén BA, Spangfort EV, Nygren ÅL, Nordemar R (1994) The disability rating index: an instrument for the assessment of disability in clinical settings. J Clin Epidemiol 47:1423–1434

    PubMed  Google Scholar 

  33. Specchia N, Pagnotta A, Toesca A, Greco F (2002) Cytokines and growth factors in the protruded intervertebral disc of the lumbar spine. Eur Spine J 11:145–151

    Article  PubMed  Google Scholar 

  34. Tullberg T, Isacson J, Weidenhielm L (1993) Does microscopic removal of lumbar disc herniation lead to better results than the standard procedure? Spine 18:24–27

    Google Scholar 

  35. Watters III WC, Temple AP, Granberry M (1989) The use of dexamethasone in primary lumbar disc surgery. Spine14:440–442

  36. Weber H (1983) Lumbar disc herniation a controlled, prospective study with ten years observation. Spine 8:131–140

    CAS  PubMed  Google Scholar 

  37. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank Professor Steven J. Linton, PhD, Department of Occupational and Environmental Medicine, Örebro University Hospital, for valuable advice. The study was supported by Örebro County Council.

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Authors and Affiliations

  1. Department of Orthopaedics, Örebro University Hospital, 701 85, Örebro, Sweden

    Anders Lundin, Heinz Kogler & Lars Samuelsson

  2. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden

    Kjell Axelsson

  3. Center for Clinical Research, Örebro University Hospital, Örebro, Sweden

    Anders Magnuson

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  1. Anders Lundin
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  2. Anders Magnuson
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  3. Kjell Axelsson
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  4. Heinz Kogler
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  5. Lars Samuelsson
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Corresponding author

Correspondence to Anders Lundin.

Additional information

This paper was presented at the EuroSpine 2001 Annual Meeting, Gothenburg, Sweden

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Lundin, A., Magnuson, A., Axelsson, K. et al. The effect of perioperative corticosteroids on the outcome of microscopic lumbar disc surgery. Eur Spine J 12, 625–630 (2003). https://doi.org/10.1007/s00586-003-0554-7

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  • DOI: https://doi.org/10.1007/s00586-003-0554-7

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