Local Steroid Application for Early Postsurgical Lumbar Discectomy Pain Relief

Background: Edema and inflammation of the nerve root because of its handling are responsible for creating postoperative uncomfortable situations for many patients. Several adjuncts to lumbar discectomy procedure to reduce nerve root inflammation have been studied in literature. Objective: The purpose of this study was to evaluate the efficacy of local application of gelfoam soaked with low-dose Depo-Medrol (methylprednisolone) on the affected nerve root, in controlling early postoperative pain following lumbar discectomy surgeries. Patients and Methods: Thirty patients with single level lumbar disc prolapse candidate for discectomy were randomly allocated in 2 equal groups (n=15), group A (steroid group) and group B (control group). After performing a standard hemipartial lamimectomy and discectomy and before the closure of fascia at the end of surgery, a gelfoam soaked with 40 mg methylprednisolone acetate was left on the decompressed nerve root in the steroid group and a saline soaked gelfoam was applied to the nerve root in the control group. Postoperative back and radicular pain intensity was assessed by a visual analogue scale (VAS) before and at 24, 48 hours and 1 week after surgery. Results: There were no statistical difference in back and radicular intensity between the two groups preoperatively and at 24 hours postoperatively. However, the difference became significant between the 2 groups at 48 hours postoperatively and at final follow-up after 1 week which suggests that after first 24 hours the pain relief in the steroid group was significant compared to the control group. Conclusion: Local application of low-dose steroid alone can sufficiently reduce the postoperative back and leg pain effectively after 48 hours and at 1 week follow up.