Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease. A review.

Abstract

This systematic review assesses the efficacy of epidural steroids on adults undergoing lumbar spine surgery for degenerative spinal disease. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase databases were searched for relevant articles. Search terms included "laminectomy," "discectomy," and "steroid." Randomized and quasi-randomized controlled trials of adults undergoing lumbar spinal surgery for degenerative spinal disease were included. The main outcomes were pain, quality of life, total analgesic agent consumption, postoperative length of hospital stay, the ability to return to full-time work, and adverse events. Twelve trials (involving 1053 patients) were included. Epidural steroids reduced back pain at 12-24 hours postoperatively (standardized mean difference [SMD] -1.26, 95% CI -2.35 to -0.0.18, p = 0.02), and radicular pain at 1 week postoperatively (SMD -0.71, 95% CI -1.19 to -0.24, p = 0.003) and 1-2 months postoperatively (SMD -2.14, 95% CI -3.47 to -0.81, p = 0.002). Epidural steroids decreased postoperative consumption of analgesic agents (SMD -0.38, 95% CI -0.62 to -0.14, p = 0.002), length of stay (SMD -0.95, 95% CI -1.62 to -0.27, p = 0.006) and the risk of not returning to full-time work at 1 year (relative risk of 0.27, 95% CI 0.13-0.57, p = 0.0006). There was no significant difference in quality of life or in adverse events. There is evidence that epidural steroids decrease pain in the short term and shorten length of stay in adults undergoing lumbar spinal surgery for degenerative spinal disease. Most of the evidence comes from studies without validated outcomes and that selectively report positive results. More research is required before establishing perioperative epidural steroids as an effective adjunct to surgery for reducing pain in the long term.