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Incidence and Predictors of Oral Steroid Use Shortly Following Lumbar Microdiscectomy
Henry Avetisian1, Will Karakash, David McCavitt
1Department of Orthopaedic Surgery, Keck School of Medicine, The University of Southern California, Los Angeles, CA.
Study Design:
Retrospective cohort study.
Objective:
To determine the incidence and identify risk factors for radiculopathy requiring treatment with oral glucocorticoids within 1 month following lumbar microdiscectomy (MD).
Background:
Lumbar MD often provides immediate relief of low back and leg pain; however, some patients experience recurrent postoperative radicular pain. While oral steroids are commonly used to manage this condition, the frequency of their use and associated risk factors remain unclear.
Materials And Methods:
The PearlDiver national database was queried for patients who underwent lumbar MD for disc herniation. Patients were stratified based on whether they were prescribed oral steroids (prednisone, methylprednisolone, and prednisolone) from postoperative day 1 to day 30. Patient demographics and comorbidities were compared using χ 2 analysis and the Student t test. Multivariate logistic regression controlling for age, sex, Elixhauser Comorbidity Index (ECI), and the number of levels operated on was used to identify independent risk factors.
Results:
Among 326,315 patients who underwent lumbar MD, 38,455 (11.78%) received oral steroids within 30 days postoperatively. Patients who received steroids were more likely to be female (51.88% vs . 46.70%) and have a higher ECI (3.04 vs . 2.71; P < 0.001). Independent risk factors included opioid use [OR: 2.10, (2.05-2.15)], far lateral disc herniation [OR: 1.37, (1.29-1.46)], female sex [OR: 1.23 (1.21-1.26)], prior epidural steroid injection [OR: 1.18, (1.15-1.21)], fibromyalgia [OR: 1.17, [1.13-1.20)], tobacco use [OR: 1.09, (1.08-1.13)], delaying surgery >90 days from disc herniation [OR: 1.14, (1.11-1.17)], depression [OR: 1.12, (1.09-1.15)], ECI [OR: 1.07, (1.06-1.071)], and revision MD [OR: 1.05, (1.01-1.09); all P < 0.05].
Conclusion:
This study found that 11.78% of patients undergoing lumbar MD require oral steroids postoperatively, reflecting a significant subset of patients with postoperative radiculopathy. Several patient-related and procedural-related risk factors were identified. Further research is warranted to clarify the role of oral steroids and develop strategies to reduce postoperative radiculopathy.
Insights
Nearly 12% of patients undergoing lumbar microdiscectomy require oral steroids for postoperative radiculopathy. Female gender, opioid use, and fibromyalgia are key risk factors identified in this study.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Pain Management
Background:
- Lumbar microdiscectomy (MD) frequently alleviates back and leg pain.
- Some patients experience recurrent radicular pain post-MD, often managed with oral steroids.
- The incidence and risk factors for steroid use post-MD are not well-defined.
Purpose of the Study:
- Determine the incidence of oral glucocorticoid use within one month after lumbar microdiscectomy.
- Identify patient- and procedure-related risk factors for this postoperative radiculopathy treatment.
Main Methods:
- Retrospective cohort study utilizing the PearlDiver national database.
- Analysis of 326,315 patients undergoing lumbar MD for disc herniation.
- Stratification based on oral steroid prescription (postoperative days 1-30) and multivariate logistic regression.
Main Results:
- 11.78% (38,455/326,315) of patients received oral steroids postoperatively.
- Steroid recipients were more likely female and had higher Elixhauser Comorbidity Index (ECI).
- Independent risk factors included opioid use, far lateral herniation, female gender, prior epidural steroid injection, fibromyalgia, tobacco use, delayed surgery, depression, higher ECI, and revision MD.
Conclusions:
- A significant subset of lumbar microdiscectomy patients (11.78%) require oral steroids for postoperative radiculopathy.
- Multiple patient and procedural factors are associated with increased steroid use.
- Further research is needed to optimize steroid use and reduce radiculopathy post-MD.
