Subjective Intraoperative Use of Epidural Steroid Administration Following Discectomy

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.

Inclusion criteria

• Presenting to the University of Missouri hospital system - including the University of Missouri Hospital and Missouri Orthopaedic Institute - with a clinical assessment indicative of a lumbar disc herniation
• Failed conservative treatment - rest, anti-inflammatory medications, physical therapy
• Radiculopathy present - positive tension signs or sensory/motor neurologic deficits present
• Recent MRI confirming single-level lumbar disc herniation corresponding to clinical evaluation

Exclusion criteria

• Concomitant spinal stenosis, segmental instability, or spondylolisthesis
• Previous surgery at the affected level or recurrent herniation
• Underlying disease that may affect response to steroids - immunocompromise, use of chronic steroids or immunosuppression
• Pregnancy - qualitative human chorionic gonadotropin (hCG) testing will be performed prior to enrollment
• Diagnosis of or symptoms concerning for cauda equina syndrome