The purpose of this study is to determine a grading system for inflammation in lumbar disc herniation and which groups, if any, benefit most from the administration of an intra-operative epidural steroid.
Intraoperative epidural administration of steroids following discectomy for herniated lumbar disc has been the topic of multiple studies in the literature. The results have been mixed, with the majority of the studies finding some benefit, but outcomes have varied drastically amongst the many studies. The aim of this study is to develop a grading scale for intraoperative assessment of nerve root inflammation to determine if this subjective assessment is an adequate indicator for response to epidural steroids following discectomy. Patients will be allocated randomly preoperatively to the intervention group versus control group. Pictures of the spinal cord and associated nerve root will be captured intraoperatively. These pictures will be scrutinized postoperatively and an inflammation grade will be assigned. The investigators will then identify if nerve roots with a higher-grade of inflammation respond differently to epidural steroid administration when compared to lesser-grades of inflammation. This will be measured with the a variety of outcome measures.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
200
Patients included in the treatment group will have their surgical site lavaged with dexamethasone at the end of their surgery.
Patients included in the placebo group will have their surgical site lavaged with sterile saline at the end of their surgery.
Missouri Orthopaedic Institute
Columbia, Missouri, United States
RECRUITINGPost Operative Pain Scores
Comparing post operative pain scores between treatment and placebo group. Using Visual Analogue Scale (VAS) pain score with scale 0 to 10 with 0 being no pain and 10 being the worst pain of your life.
Time frame: Until final follow up (up to 8 weeks)
Post Operative Oswestry Disability Index
Comparing post operative disability scores between treatment and placebo group. Using Oswestry Disability Index (ODI) to measure a patient's permanent functional disability and low back functional outcome tools.
Time frame: Until final follow up (up to 8 weeks
Length of stay
Determining how long patient is in hospital
Time frame: Until final follow up (up to 8 weeks)
Post Operative Opioid Usage
comparing opioid usage post operatively
Time frame: Until final follow up (up to 8 weeks)
Post Operative Complications
comparing rate of post-op infections
Time frame: Until final follow up (up to 8 weeks)
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