Our Summary

This research paper is about a study that aimed to see if using epidural steroids (ES) after a certain type of back surgery (lumbar discectomy) helps reduce pain and improve recovery. This surgery is usually done when other treatments for herniated lower back discs have failed. The researchers analyzed data from 12 previous studies involving 1006 patients, half of whom received ES after surgery and half of whom received a placebo. They looked at things like back and leg pain, use of morphine for pain relief, length of hospital stay, and complications after surgery. They found that, overall, patients who received ES reported less back and leg pain, used less morphine, and had shorter hospital stays compared to those who received a placebo. However, there was no significant difference in complications between the two groups. The researchers also found that ES seemed to help reduce the need for morphine after conventional surgery but not after minimally invasive surgery.

FAQs

  1. What was the primary aim of the study conducted on the use of epidural steroids after lumbar discectomy?
  2. What benefits did the patients who received epidural steroids experience compared to those who received a placebo?
  3. Did the use of epidural steroids after lumbar discectomy have any impact on the complications after surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about discectomy is to follow post-operative instructions carefully, including avoiding heavy lifting, bending, or twisting for a certain period of time to allow the spine to heal properly. It is also important to attend follow-up appointments and physical therapy sessions to ensure proper recovery and rehabilitation. Additionally, maintaining a healthy weight, staying active with low-impact exercises, and practicing good posture can help prevent future back issues.

Suitable For

Patients who are typically recommended discectomy are those who have not had success with other treatments for herniated lower back discs, such as physical therapy, medications, or injections. These patients may be experiencing debilitating back and leg pain, weakness, numbness, or tingling due to nerve compression from the herniated disc. Discectomy is often recommended for patients who have tried conservative treatments for at least 6 weeks and have not experienced significant improvement in their symptoms. Additionally, patients who have significant neurological deficits, such as difficulty walking or loss of bowel or bladder control, may also be recommended for discectomy to prevent further nerve damage.

Timeline

Before discectomy:

  1. Patient experiences back and leg pain that does not improve with conservative treatments such as physical therapy or medication.
  2. Patient undergoes diagnostic tests such as MRI or CT scan to confirm a herniated disc.
  3. Patient consults with a surgeon to discuss the option of lumbar discectomy surgery.
  4. Patient undergoes pre-operative evaluations and preparations for surgery.

After discectomy:

  1. Patient undergoes lumbar discectomy surgery to remove the herniated disc material pressing on the nerves.
  2. Patient is monitored in the hospital for a period of time post-surgery.
  3. Patient may experience some pain and discomfort in the immediate post-operative period.
  4. Patient begins physical therapy and rehabilitation exercises to strengthen the back and improve mobility.
  5. Patient may be prescribed pain medication to manage post-operative pain.
  6. Patient may experience gradual improvement in symptoms such as back and leg pain over time.
  7. Patient follows up with the surgeon for post-operative evaluations and monitoring of recovery progress.

What to Ask Your Doctor

  1. What is a lumbar discectomy and why is it recommended for me?
  2. What are the potential risks and complications associated with this surgery?
  3. How long is the recovery process expected to be after a lumbar discectomy?
  4. What are the potential benefits of using epidural steroids after surgery?
  5. How will the decision to use epidural steroids be made in my case?
  6. Are there any potential side effects or risks associated with using epidural steroids?
  7. How will the effectiveness of epidural steroids be measured in my case?
  8. Will using epidural steroids affect my overall recovery and outcome from the surgery?
  9. Are there any alternative pain management options that I should consider instead of epidural steroids?
  10. How will my pain management plan be adjusted if epidural steroids are not effective in reducing my pain after surgery?

Reference

Authors: Arirachakaran A, Siripaiboonkij M, Pairuchvej S, Setrkraising K, Pruttikul P, Piyasakulkaew C, Kongtharvonskul J. Journal: Eur J Orthop Surg Traumatol. 2018 Dec;28(8):1589-1599. doi: 10.1007/s00590-018-2229-4. Epub 2018 May 29. PMID: 29845327