Korean J Pain.  2022 Jan;35(1):97-105. 10.3344/kjp.2022.35.1.97.

Outcomes of epidural steroids following percutaneous transforaminal endoscopic discectomy: a meta-analysis and systematic review

• Song Y
• Li C
• Guan J
• Li C
• Wu H
• Cheng X
• Ling B
• Zhang J

• KMID: 2524653
• DOI: http://doi.org/10.3344/kjp.2022.35.1.97

Abstract

Background
Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED.
Methods
We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work.
Results
A total of 451 patients were included in three randomized and two nonrandomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001).
Conclusions
Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.

Keyword

Diskectomy; Percutaneous; Endoscopy; Injections; Epidural; Lumbar Vertebrae; Meta-Analysis; Pain; Postoperative; Saline Solution; Steroids; Systematic Review; Visual Analog Scale

Figure

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  Fig. 1 Risk of bias assessment using the Cochrane risk of bias tool for randomized controlled trials included in a meta-analysis.

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  Fig. 2 Flow chart illustrating the study selection process. RCT: randomized controlled trial, LDH: lumbar disc herniation.

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  Fig. 3 Forest plot of postoperative visual analogue scale scores for leg pain in a meta-analysis on the efficacy of epidural steroids and saline alone for percutaneous transforaminal endoscopic discectomy. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.

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  Fig. 4 Forest plot of postoperative visual analogue scale scores for lumbar pain in a meta-analysis on the efficacy of epidural steroids and saline alone for percutaneous transforaminal endoscopic discectomy. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.

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  Fig. 5 Forest plot of postoperative Oswestry Disability Index in a meta-analysis on the efficacy of epidural steroids and saline alone for percutaneous transforaminal endoscopic discectomy. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.

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  Fig. 6 Forest plot of time of hospital stay in a meta-analysis on the efficacy of epidural steroids andsaline alone for percutaneous transforaminal endoscopic discectomy. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.

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  Fig. 7 Forest plot of time of return to work in a meta-analysis on the efficacy of epidural steroids and saline alone for percutaneous transforaminal endoscopic discectomy. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.

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