Efficacy of Intraoperative Epidural Triamcinolone (Kenacort^®) Application in Lumbar Microdiscectomy: A Matched-Control Study

Aim: To investigate whether the intraoperative application of epidural steroids (ES) on the decompressed nerve root improves short- and mid-term subjective and objective clinical outcome after lumbar microdiscectomy.

Methods: Retrospective analysis of a prospective IRB-approved two-center database including consecutive patients undergoing lumbar microdiscectomy. All patients who have received ES (40mg triamcinolone (Kenacort^®); intervention group) were matched by age and sex to patients who had not received ES (control group). Objective functional impairment (OFI) was determined using age- and sex-adjusted T-scores. Back and leg pain (visual analog scale), functional impairment (Oswestry (ODI) and Roland-Morris disability index (RMDI), and health-related quality of life (hrQoL; Short-Form (SF)-12 physical component score (PCS) and Euro-Qol index) were measured at baseline, postoperative day three (D3) and week six (W6).

Results: N = 53 patients with ES were matched with n = 101 control subjects. There were no baseline demographic or disease-specific differences between the study groups, and preoperative pain, functional impairment and hrQoL were similar. On D3, the intervention group had less disability on the RMDI (7.4 versus 10.3, p = 0.003) and higher hrQoL on the SF-12 PCS (36.5 versus 32.7, p = 0.004). At W6, the intervention group had less disability on the RMDI (3.6 versus 5.7, p = 0.050) and on the ODI by trend (17.0 versus 24.4, p = 0.056); better hrQoL, determined by the SF-12 PCS (44.3 versus 39.9, p = 0.018), and lower OFI (T-score 100.5 versus 110.2, p = 0.005). The W6 responder status based on the minimum clinically important difference (MCID) was similar between the intervention and control group on each metric. Rates and severity of complications were similar, with a 3.8% and 4.0% re-operation rate in the intervention and control group, respectively (p = 0.272). There was a tendency for shorter hospitalization in the intervention group (5.0 versus 5.8 days, p = 0.066).

Conclusions: Intraoperative application of ES on the decompressed nerve root is an effective adjunct treatment to lower subjective and objective functional disability and increase hrQoL in the short- and mid-term after lumbar microdiscectomy. However, group differences were lower than the commonly accepted MCIDs of each metric, indicating that the effect size of the benefit is limited.