Effect of Intraoperative Epidural Steroid in Early Outcomes After Full-Endoscopic Lumbar Discectomy - A Randomized Controlled Trial.

Abstract

Study designRandomized controlled trial.ObjectivesThere are no high-quality studies that evaluate the impact of intraoperative epidural steroids on early outcomes of patients undergoing full-endoscopic lumbar spine surgery. We aimed to assess the effect of intraoperative epidural steroid application on early clinical outcomes.MethodsWe evaluated adult patients submitted to full-endoscopic discectomy at a neurosurgery department from September 2022 to January 2025. The primary endpoint was the mean Oswestry Disability Index (ODI) reduction 3 months after surgery. The secondary endpoints were mean ODI reduction 1 month post-op and lumbar and leg pain reduction using a numeric rating scale (NRS, 0-10) following surgery at different timepoints. After randomization and following disc herniation removal, the intervention group was given 2 mL (8 mg) of dexamethasone, and the control group was given 2 mL of saline. Outcome measures were collected at 2, 14, 30 and 90 postoperative days.ResultsNinety patients were randomized (45 for each group) and results were obtained for 78 patients (39 in each group). Mean age was 45.1 years and 50 (64%) were females. Both groups shared similar clinical characteristics and preoperative scores, and both groups achieved significant improvement following surgery. There was no difference between groups regarding mean improvement in the ODI at 1 and 3 months postoperatively. No differences were found between groups regarding mean improvement in NRS back and leg pain at different time points.ConclusionsIn this study, intraoperative administration of epidural steroid had no effect in early clinical outcomes after full-endoscopic lumbar discectomy.