Aljabi Yasser, El-Shawarby Amr, Cawley Derek T, Aherne Thomas
Department of Neurosurgery, Tawam Hospital in affiliation with Johns Hopkins Medical, Al-Ain, United Arab Emirates; Department of Orthopaedics, Beaumont Hospital, Dublin, Ireland.
Department of Neurosurgery, Tawam Hospital in affiliation with Johns Hopkins Medical, Al-Ain, United Arab Emirates.
Surgeon. 2015 Oct;13(5):245-9. doi: 10.1016/j.surge.2014.03.012. Epub 2014 Jun 7.
BACKGROUND & AIM: Intraoperative epidural corticosteroids have been used to decrease post-operative pain post-discectomy. The objective of this study is to assess the efficacy of epidural corticosteroids on post-operative pain and length of post-operative hospital stay in patients undergoing unilateral lumbar microdiscectomy.
150 consecutively treated, comparable patients with unilateral lumbar disc herniation were prospectively allocated randomly to receive either a sponge soaked in epidural corticosteroids or saline at the end of the operative procedure. The intensity of spontaneous pain was quantified by using the Oswestry low back pain index pre-operatively, at discharge, at week 1 follow-up and at 1st month of follow up. At the same intervals, each patient underwent the passive straight leg-raising test (PSLRT) and Visual Analogue Scale (VAS) testing. The duration of hospital stay, time taken to return to daily life activities and quantity of analgesia consumed post-operatively were also recorded.
The mean hospital stay was 1.3 ± 0.9 days in the corticosteroids group (group 1) compared to 3.2 ± 1.2 in the control group (group 2). The mean interval until return to daily life activities was 6.7 ± 2.1 days in group 1 versus 9.6 ± 4.1 days in group 2. No statistically significant difference was measured between the steroid-treated and control groups when the data were stratified for sex, age, and site of disc herniation. Differences in the OLBI scores were statistically significant at all post-operative intervals. At baseline (preoperatively), group 1 (DepoMedrol™ group) had an average score of 72.3% (±2.6%) compared to 74.6% (±3.1%) in group 2 (Control group) (P = 0.45). At discharge, OLBI scores declined to 49.7% (±4.5%) in group 1 compared to 63.5% (±3.9%) in group 2 (P = 0.034). At week 1 follow-up, OLBI scores further declined to 41.3% (±2.9%) in group 1 versus 54.2% (±5.3%) in group 2 (P = 0.014). After one month of follow-up, OLBI scores were 34.1% (±6.7%) in group 1 and 42.6% (±4.1%) in group 2 (P = 0.004). Results of VAS and PSLRT are also documented in the manuscript. The mean postoperative analgesic medications consumed was 15.6 ± 1.9 mg of morphine equivalent in the corticosteroid group versus 10.3 ± 1.8 mg of morphine equivalent in the control group. No complications of treatment occurred in either groups.
Intraoperative application of epidural corticosteroids, Depomedrol, significantly reduces post-operative pain, length of post-operative stay and duration to return to daily living activities following lumbar discectomy.
术中硬膜外使用皮质类固醇已被用于减轻椎间盘切除术后的疼痛。本研究的目的是评估硬膜外皮质类固醇对接受单侧腰椎间盘显微切除术患者术后疼痛及术后住院时间的疗效。
150例连续接受治疗的、病情相当的单侧腰椎间盘突出症患者被前瞻性地随机分配，在手术结束时分别接受浸泡有硬膜外皮质类固醇的海绵或生理盐水。术前、出院时、随访第1周和第1个月时，使用Oswestry下腰痛指数对自发疼痛强度进行量化。在相同时间间隔，每位患者接受被动直腿抬高试验（PSLRT）和视觉模拟量表（VAS）测试。还记录了住院时间、恢复日常生活活动所需时间以及术后镇痛药的消耗量。
皮质类固醇组（第1组）的平均住院时间为1.3±0.9天，而对照组（第2组）为3.2±1.2天。第1组恢复日常生活活动的平均间隔时间为6.7±2.1天，第2组为9.6±4.1天。当按性别、年龄和椎间盘突出部位对数据进行分层时，类固醇治疗组和对照组之间未测得统计学上的显著差异。在所有术后时间间隔，OLBI评分的差异均具有统计学意义。在基线（术前）时，第1组（得宝松组）的平均评分为72.3%（±2.6%），而第2组（对照组）为74.6%（±3.1%）（P=0.45）。出院时，第1组的OLBI评分降至49.7%（±4.5%），第2组为63.5%（±3.9%）（P=0.034）。在随访第1周时，第1组的OLBI评分进一步降至41.3%（±2.9%），第2组为54.2%（±5.3%）（P=0.014）。随访1个月后，第1组的OLBI评分为34.1%（±6.7%），第2组为42.6%（±4.1%）（P=0.004）。手稿中也记录了VAS和PSLRT的结果。皮质类固醇组术后平均消耗的镇痛药物为15.6±1.9毫克吗啡当量，而对照组为10.3±1.8毫克吗啡当量。两组均未发生治疗相关并发症。
术中应用硬膜外皮质类固醇得宝松可显著减轻腰椎间盘切除术后的疼痛、术后住院时间及恢复日常生活活动所需的时间。
