36. Effects of intraoperative epidural steroids for lumbar spine surgery in lumbar spinal canal stenosis

BACKGROUND CONTEXT

Pain control methods after spinal surgery are not yet standardized. Postoperative pain relief effects affect patient satisfaction and postoperative rehabilitation and hospital stay. Postoperative pain relief is especially important for elderly patients. Although the effects of steroids after lumbar disc herniation surgery have been reported, their effects on lumbar spinal stenosis are still unclear.

PURPOSE

The purpose of this study is to evaluate the efficacy of intraoperative epidural steroids in lumbar canal stenosis surgery.

STUDY DESIGN/SETTING

A randomized controlled trial.

PATIENT SAMPLE

We enrolled 40 adult patients scheduled for elective lumbar decompression surgery of lumbar canal stenosis. Inclusion criteria were 60-85 years old and decompression between 1 to 3 levels. Exclusion criteria were fusion surgery, reoperation surgery, diabetes mellitus, chronic inflammatory diseases, chronic renal dysfunction, drug allergy, postoperative delirium, and dementia.

OUTCOME MEASURES

We evaluated visual analog scale (VAS), Time Up and Go Test, C-reactive proteins (CRP) of blood data, The cytokines IL-6 of wound drainage and postoperative complications. The primary outcome is VAS of postoperatively, and the second outcomes are laboratory data, postoperative complication and walking ability.

METHODS

This study was a prospective double-blind placebo controlled randomized study. Patients were divided into two groups (steroid group, control group) using a random number table before surgery. In the steroid group, we injected 6.6 mg of dexamethasone epidurally after surgical decompression and before wound closure. In the control group we similarly injected the same volume of saline epidurally before wound closure. Opioids were not used postoperatively. A Cox-2 inhibitor was taken orally for 5 days, and Diclofenac Sodium suppositories were used as needed. We investigated the VAS of average daily pain and maximum pain of back pain and leg pain on postoperative days (POD) 0, 1, 2, 3, 5, 7, and 14. The VAS evaluation was performed by a nurse who was unaware of the group classification. CRP and Time Up and Go Test were investigated preoperatively and on POD 1, 3, and 7. IL-6 was investigated in drain fluid on POD 2.

RESULTS

The steroid group had 19 patients (male 11, female 8), with an average age of 72.9 years and an average number of decompressions of 1.7. The control group had 21 patients (male 14, female 7), with an average age 74.2 years and average number of decompressions of 1.8. There were no significant differences in patient data between the two groups. Back pain (VAS) on POD 0, 1, 2, and 3 were significantly lower in the steroid group compared to the control group. Postoperative VAS (back pain/wound pain) was 41.4 mm on the day of the steroid group, 43.8 on the first day, 38.9 on the second day, and 27.6 on the third day, and 62.8 mm on the day of the control group, 63.4 on the first day, and 55.9 on the second day, and 44.3 on the third day. There was no significant difference in VAS of leg pain between the two groups. There was a significant difference in IL-6 in the drain fluid: 29.8±22.6(ng/ml) in the steroid group and 75.6±49.7 in the control group. CRP results were significantly lower in the steroid group on the third day. The control group was also significantly slower than the steroid group in the Time Up and Go Test. As for postoperative complications, no postoperative wound infection was observed in either group.

CONCLUSIONS

Local epidural injection of steroids significantly reduced low back pain and wound pain by suppressing local inflammation for several days after surgery and was useful for pain relief immediately for elderly patients after surgery of lumbar canal stenosis. Therefore, it is effective in maintaining walking ability.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.