Adjuvant Per-Operative Triamcinolone use in Lumbar Disc Surgery to  Alleviate Post-Operative Pain

Syed Adeel Ahmed; Habib Ullah  Khan; Awais Ali  Khan; Zahid  Hussain; Asif  Rasheed; Babar  Shamim

doi:10.51253/pafmj.v74i3.9959

Authors

Syed Adeel Ahmed Department of Neurosurgery, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Habib Ullah Khan Department of Neurosurgery, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Awais Ali Khan Department of Neurosurgery, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Zahid Hussain Department of Neurosurgery, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Asif Rasheed Department of Neurosurgery, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Babar Shamim Department of Neurosurgery, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i3.9959

Keywords:

Discectomy, Post-operative pain, Triamcinolone acetate

Abstract

Objective: To study the adjuvant per-operative epidural administration of Triamcinolone in lumbar disc surgery to alleviate post-operative pain.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Neurosurgery, Combined Military Hospital, Rawalpindi Pakistan, from Oct 2021 to Sep 2022

Methodology: Hundred patients aged 20 to 80 years, of either gender, with a single-level prolapsed intervertebral disc and nerve root compression were included and underwent unilateral single-level decompression. A pre-operative MRI scan of the lumbo-sacral spine was done to confirm the diagnosis. All patients initially received conservative management (analgesics and physiotherapy) but failed to respond to it. They were divided into two groups by the lottery method. In Group A, an epidural steroid was administered, while Group B acted as the control. Pain was recorded pre-operatively at 24 hours and then at 1 and 2 weeks post-operatively using the Visual Analogue Scale.

Results: The pre-operative median VAS of Groups A and B was not significant at pre-operation. After 24 hours of operation, the median VAS of Group A patients was VAS 3 (1), while in Group-B it was 2 (1), (p-value of 0.001). After 1 week, the median VAS of Group-A patients was 2 (2) and Group- B was 3 (1), with a significant p value of 0.024. After 2 weeks, the median VAS of Group-A patients was 1 (1) and Group B was 2 (1), with a significant p value of 0.015.

Conclusion: Intra-operative epidural and foraminal administration of steroids in single-level lumbar disc surgery significantly reduce...

Downloads

Download data is not yet available.

References

Kim SK, Choe JY. Comorbidities and Health-Related Quality of Life in Subjects with Spine Osteoarthritis at 50 Years of Age or Older: Data from the Korea National Health and Nutrition Examination Survey. Medicina 2022; 58(1): 126.

https://doi.org/10.3390/medicina58010126

2. Berg AJ, Ahmadje U, Jayanna HH, Trégouët P, Sanville P, Kapoor V. The prevalence of lumbar disc degeneration in symptomatic younger patients: A study of MRI scans. J Clin Orthop Trauma 2020; 11(5): 932-936.

https://doi.org/10.1016/j.jcot.2020.07.021

Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med 2017; 10(4): 507-516.

https://doi.org/10.1007/s12178-017-9441-4

Xie G, Liang C, Yu H, Zhang Q. Association between poly-morphisms of collagen genes and susceptibility to intervertebral disc degeneration: a meta-analysis. J Orthop Surg Res 2021; 16(1): 616. https://doi.org/10.1186/s13018-021-02724-8

Baldoni M, Gu W. Effect of fixed charge density on water content of IVD during bed rest: A numerical analysis. Med Eng Phys 2019; 70: 72-77.

https://doi.org/10.1016/j.medengphy.2019.06.011

Zielinska N, Podgorski M, Haladaj R, Polguj M, Olewnik L. Risk Factors of Intervertebral Disc Pathology-A Point of View Formerly and Today-A Review. J Clin Med2021; 10: 409. https://doi.org/10.3390/jcm10030409

Ge Y, Chen Y, Guo C, Luo H, Fu F, Ji W, et al. Pyroptosis and Intervertebral Disc Degeneration: Mechanistic Insights and Therapeutic Implications. J Inflamm Res 2022; 15: 5857-71. https://doi.org/10.2147/JIR.S382069

Lama P, Le Maitre CL, Harding IJ, Dolan P, Adams MA. Nerves and blood vessels in degenerated intervertebral discs are confined to physically disrupted tissue. J Anat 2018; 233(1): 86-97.

https://doi.org/10.1111/joa.12817

Wang Y, Che M, Xin J, Zheng Z, Li J, Zhang S. The role of IL-1β and TNF-α in intervertebral disc degeneration. Biomed Pharmacother. 2020; 131: 110660.

https://doi.org/10.1016/j.biopha.2020.110660

Vo N, Couch B, Lee J, Sowa G, Kang J, Rebecca S. Actions of Prostaglandins on Human Nucleus Pulposus Metabolism Inferred by Cyclooxygenase 2 Inhibition of Cytokine Activated Cells. Neurospine 2020; 17(1): 60-68.

https://doi.org/10.14245/ns.2040050.025

Rakan A, Aldurgham R, Al Abdallat A, Haddad S, Ibrahim J, Alqroom RY, et al. The Lead of Direct Adjuvant Intraoperative Foraminal Steroids' Infiltration. Anesth Essays Res. 2022; 16(2): 187-190.

https://doi.org/10.4103/aer.aer_88_22

Khan AN, Jacobsen HE, Khan J, Filippi CG, Levine M, Lehman RA Jr, et al. Inflammatory biomarkers of low back pain and disc degeneration: a review. Ann N Y Acad Sci 2017; 1410(1): 68-84. https://doi.org/10.1111/nyas.13551

Liu Y, Wei J, Zhao Y, Zhang Y, Han Y, Chen B, et al. Follistatin-like protein 1 promotes inflammatory reactions in nucleus pulposus cells by interacting with the MAPK and NFκB signaling pathways. Oncotarget 2017; 8(26): 43023-43034. https://doi.org/10.18632/oncotarget.17400

Rao D, Scuderi G, Scuderi C, Grewal R, Sandhu SJ. The Use of Imaging in Management of Patients with Low Back Pain. J Clin Imaging Sci 2018; 8: 30.

https://doi.org/10.4103/jcis.JCIS_16_18

Kim JH, van Rijn RM, van Tulder MW, Koes BW, de Boer MR. Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic review. Chiropr Man Therap 2018; 26: 37.

https://doi.org/10.1186/s12998-018-0207-x

Liu XH, Du YM, Cong HJ, Liu GZ, Ren YE. Effects of Continuous Epidural Injection of Dexamethasone on Blood Glucose, Blood Lipids, Plasma Cortisol and ACTH in Patients With Neuropathic Pain. Front Neurol 2021; 11: 564643.

https://doi.org/10.3389/fneur.2020.564643

Wilson-Smith A, Chang N, Lu VM, Mobbs RJ, Epidural Steroids at Closure After Micro-discectomy/Laminectomy for Reduction of Postoperative Analgesia: Systematic Review and Meta-Analysis. World Neurosurg 2018; 110: e212-e221.

https://doi.org/10.1016/j.wneu.2017.10.133

Korhonen T, Karppinen J, Paimela L, Malmivaara A, Lindgren KA, Bowman C, et al. The treatment of disc-herniation-induced sciatica with infliximab: one-year follow-up results of FIRST II, a randomized controlled trial. Spine 2006; 31(24): 2759-2766.

https://doi.org/10.1097/01.brs.0000245873.23876.1e

Costelloe C, Burns S, Yong RJ, Kaye AD, Urman RD. An Analysis of Predictors of Persistent Postoperative Pain in Spine Surgery. Curr Pain Headache Rep 2020; 24(4): 11.

https://doi.org/10.1007/s11916-020-0842-5

Prabhakar NK, Chadwick AL, Nwaneshiudu C, Aggarwal A, Salmasi V, Lii TR, et al. Management of Postoperative Pain in Patients Following Spine Surgery: A Narrative Review. Int J Gen Med 2022; 15: 4535-4549.

https://doi.org/10.2147/IJGM.S292698

Wong HK, Tan KJ. Effects of corticosteroids on nerve root recovery after spinal nerve root compression. Clin Orthop Relat Res 2002; (403): 248-252.

https://doi.org/10.1097/00003086-200210000-00036

Hu A, Gu X, Guan X, Fan G, He S. Epidural versus intravenous steroids application following percutaneous endoscopic lumbar discectomy. Medicine 2018; 97(18): e0654.

https://doi.org/10.1097/MD.0000000000010654