Efficacy of intraoperative epidural triamcinolone application in lumbar microdiscectomy: a matched-control study.
J Neurosurg Spine
; 28(3): 291-299, 2018 03.
Article
en En
| MEDLINE
| ID: mdl-29243999
ABSTRACT
OBJECTIVE The purpose of this study was to investigate whether the intraoperative application of an epidural steroid (ES) on the decompressed nerve root improves short- and midterm subjective and objective clinical outcomes after lumbar microdiscectomy. METHODS This study was a retrospective analysis of a 2-center database including consecutive cases in which patients underwent lumbar microdiscectomy. All patients who received ES application (40 mg triamcinolone, ES group) were matched by age and sex to patients who had not received ES application (control group). Objective functional impairment (OFI) was determined using age- and sex-adjusted T-scores of the Timed Up and Go (TUG) test. Back and leg pain (visual analog scale), functional impairment (Oswestry Disability Index [ODI], Roland-Morris Disability Index [RMDI], and health-related quality of life (hrQoL; 12-Item Short Form Health Survey [SF-12] physical component summary [PSC] score and EuroQol [EQ-5D index]) were measured at baseline, on postoperative day 3, and at postoperative week 6. RESULTS Fifty-three patients who received ES application were matched with 101 controls. There were no baseline demographic or disease-specific differences between the study groups, and preoperative pain, functional impairment, and hrQoL were similar. On postoperative day 3, the ES group had less disability on the RMDI (mean 7.4 vs 10.3, p = 0.003) and higher hrQoL as determined by the SF-12 PCS (36.5 vs 32.7, p = 0.004). At week 6, the ES group had less disability on the RMDI (3.6 vs 5.7, p = 0.050) and on the ODI by trend (17.0 vs 24.4, p = 0.056); better hrQoL, determined by the SF-12 PCS (44.3 vs 39.9, p = 0.018); and lower OFI (TUG test T-score 100.5 vs 110.2, p = 0.005). The week 6 responder status based on the minimum clinically important difference (MCID) was similar in the ES and control groups for each metric. The rates and severity of complications were similar, with a 3.8% and 4.0% reoperation rate in the ES group and control group, respectively (p = 0.272). There was a tendency for shorter hospitalization in the ES group (5.0 vs 5.8 days, p = 0.066). CONCLUSIONS Intraoperative ES application on the decompressed nerve root is an effective adjunct treatment that may lower subjective and objective functional impairment and increase hrQoL in the short and intermediate term after lumbar microdiscectomy. However, group differences were lower than the commonly accepted MCIDs for each metric, indicating that the effect size of the benefit is limited. â CLASSIFICATION OF EVIDENCE Type of question therapeutic; study design:
retrospective cohort trial; evidence Class II.Palabras clave
ASA = American Society of Anesthesiologists; BMI = body mass index; CCI = Charlson Comorbidity Index; ES = epidural steroid; LBP = low-back pain; LDH = lumbar disc herniation; MCID = minimum clinically important difference; ODI = Oswestry Disability Index; OFI = objective functional impairment; PCS = physical component summary; RMDI = Roland-Morris Disability Index; RR = risk ratio; SF-12 = 12-Item Short Form Health Survey; TUG = Timed Up and Go; VAS = visual analog scale; complications; epidural steroid application; hrQoL = health-related quality of life; lumbar disc surgery; minimum clinically important difference; objective functional impairment; outcome; responder status; triamcinolone
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Triamcinolona
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Degeneración del Disco Intervertebral
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Manejo del Dolor
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Vértebras Lumbares
Tipo de estudio:
Observational_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Año:
2018
Tipo del documento:
Article