LAUSR

STUDY DESIGN Prospective Randomized. OBJECTIVE Intraoperative methylprednisolone is a common adjunct following microscopic laminectomy/microdiskectomy. The goal of epidural instillation is rapid symptomatic reduction in irritation of neural elements. There is inconsistent data supporting its use intraoperatively. To understand if this maneuver results in any clinical effect, we performed a multi-year prospective study. SUMMARY OF BACKGROUND DATA Previous work has demonstrated equivocal effects on pain with suggestion of an increased risk of complication. These studies tend to suffer from small sample size and short follow-up. METHODS Study obtained IRB approval. During the study period 2013-2019, nearly equivalent numbers of patients having received steroid during MIS decompressions were followed. Primary outcomes included pain (VAS) and disability (ODI at two weeks and four months. Secondary outcomes included complications, readmissions, and reoperation rate during the study period. RESULTS 486 patients were followed for mean follow up of 5.17 years. The index case was more likely to be a revision surgery in the steroid group. Across all patients, there was no difference in pain at two weeks or four months. Disability was reduced at two weeks in the steroid group (ODI 16.71 vs. 21.02, P=0.04) but not at four months. By subgroup analysis, this is largely explained by ODI reduction in patients with high preoperative ODI (13.00 vs. 43.43, P=0.03). Patients in the steroid cohort were more likely to undergo subsequent spinal surgery during the study period. CONCLUSION Methylprednisolone instillation is associated with a large, transient reduction in ODI for patients with high preoperative ODI; there is no measurable effect on pain. While there is an increased risk of subsequent reoperation, it is not for wound breakdown or infection. Therefore, the technique is likely best reserved for patients with significant preoperative disability.