Epidural Steroid Applications in Lumbar Spine Surgery

Epidural administration of glucocorticoids in lumbar spine surgery has become a cornerstone of perioperative analgesia, aimed at mitigating inflammatory responses within the epidural space and reducing nociceptive sensitisation. Steroid molecules, typically triamcinolone acetonide or dexamethasone, are delivered directly to the site of neural irritation or surgical trauma to inhibit pro-inflammatory mediators, stabilise neuronal membranes and diminish postoperative pain. Intraoperative placement of epidural steroids during decompression or discectomy procedures has been shown to lower early postoperative pain scores, decrease opioid consumption and, in selected series, shorten hospital stay without increasing the rate of steroid-related complications. Attention has focussed on optimal timing, dosage and combination with local anaesthetics such as bupivacaine, as well as on the expansion of minimally invasive techniques like percutaneous endoscopic interlaminar discectomy. Recent work explores the addition of adjuvant agents to prolong analgesia and refine patient-centred care pathways, all within a framework that balances efficacy with safety and cost-effectiveness.

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Epidural Steroid Applications in Lumbar Spine Surgery publication trend

The graph below shows the total number of articles in epidural steroid applications in lumbar spine surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Epidural space: The anatomical compartment between the dura mater and the vertebral canal, accessible for delivery of analgesic or anti-inflammatory agents.

Glucocorticoid: A class of steroid hormones, such as dexamethasone or triamcinolone, used to suppress inflammation by modulating immune cell activity and cytokine release.

Percutaneous endoscopic interlaminar discectomy (PEID): A minimally invasive surgical technique that uses an endoscope to remove herniated disc material via a small interlaminar window, often combined with local steroid application.

Caudal analgesia: Regional pain control achieved by injecting anaesthetic or steroid admixtures through the sacral hiatus into the epidural space, commonly employed in lumbosacral procedures.

References

1. Epidural steroids following percutaneous endoscopic interlaminar discectomy. Medicine (2020).
2. Efficacy of intraoperative epidural steroids in lumbar discectomy: a systematic review. BMC Musculoskeletal Disorders (2014).
3. Efficacy and safety of epidural steroid injection following discectomy for patients with lumbar disc herniation. Medicine (2020).
4. Dexmedetomidine vs hyaluronidase addition to fluoroscopy-guided caudal analgesia with steroid in lumbosacral spine surgery. A comparative double blinded study. Egyptian Journal of Anaesthesia (2021).