Intravenous steroids help prevent surgery in lumbar disc herniation patients with radiculopathy

In patients with lumbar disc herniation and intractable radicular pain, the use of intravenous steroid treatment can help reduce the need for surgery, reports a recent study.

Researchers conducted a retrospective case-series of 181 patients, all of whom were free of significant neurological deficits and treated with intravenous dexamethasone. The primary outcome was whether or not the patient underwent operative treatment within 1 year of steroid administration.

Only 48 patients eventually needed to undergo surgery within 1 year of steroid treatment; the majority (n=133; 73.48 percent) did not. Six patients received surgery beyond the 1-year mark.

The researchers found no clear predictor of surgery. Age, for instance, did not differ between those who were vs were not operated on (mean, 56.63 vs 56.65 years; p=0.990). Sex distribution was also not a significant indicator of surgery (p=1.00), nor was the total number of comorbidities (mean, 1.21 vs 1.14, respectively; p=0.664).

Of note, malignancies were nominally more common in patients who did not undergo surgery, though the difference was only of borderline significance (7.5 percent vs 0 percent; p=0.065).

“We have found that only 26.51 percent of our patient cohort had undergone surgery within 1 year and an additional 3.31 percent had surgery later than 1 year after IV steroid treatment,” the researchers said. “These numbers are approximately 30-percent lower than the expected 43–44 percent, making the 13-percent difference the possible treatment effect.

“Further studies are needed to determine the mechanism of this effect and its generalizability,” they added.