====== Lumbar Epidural Steroid ======

===== Epidural steroids following discectomy =====

Perioperative [[epidural steroid]]s after routine surgery for [[lumbar degenerative disease]] may result in a small reduction of post-op [[pain]], [[length of stay]], and the risk of not returning to work at 1 year, but most of the [[evidence]] originates from studies not using validated [[outcome]] assessment that favor positive results, and further study is recommended (various agents, dosages, co-administered drugs, and delivery methods were reported)
((Ranguis SC, Li D, Webster AC. Perioperative epi- dural steroids for lumbar spine surgery in degen- erative spinal disease. J Neurosurg Spine. 2010; 13:745–757)).
However, the combination of systemic [[steroid]]s at the start of the case (Depo-Medrol® 160 mg IM and [[methylprednisolone]] sodium succinate (Solu-Medrol®) 250 mg IV) combined with infiltration of 30 ml of 0.25% [[bupivacaine]] (Marcaine®) into the [[paraspinal muscle]]s at incision and closure, may reduce [[hospital stay]] and post-op narcotic requirements
((Glasser RS, Knego RS, Delashaw JB, et al. The Perioperative Use of Corticosteroids and Bipuvicaine in the Management of Lumbar Disc Disease. J Neurosurg. 1993; 78:383–387)).

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There is relatively strong evidence that intraoperative [[epidural steroid]]s are effective in reducing pain in the early stage and reducing consumption of analgesia. There is also relatively strong evidence that they are ineffective in reducing pain in the late stage and in reducing duration of hospital stay. The evidence for their effectiveness in reducing pain in the intermediate stage is considered relatively weak. The heterogeneity between the trials makes it difficult to make undisputed conclusions and it indicates the need for a large multicenter trial with validated outcome measures that are recorded at fixed time intervals
((Jamjoom BA, Jamjoom AB. Efficacy of intraoperative epidural steroids in lumbar
discectomy: a systematic review. BMC Musculoskelet Disord. 2014 May 5;15:146.
doi: 10.1186/1471-2474-15-146. Review. PubMed PMID: 24885519; PubMed Central
PMCID: PMC4014751.
)).

===== Lumbar epidural steroid injection =====

see [[Lumbar epidural steroid injection]]