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Corticosteroids peroperatively diminishes damage to the C-fibers in microscopic lumbar disc surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
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2005 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 30, no 21, 2362-2368 p.Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN:

A subgroup analysis of patient outcomes from a double-blind randomized controlled study comparing corticosteroid versus saline in microscopic lumbar disc surgery.

OBJECTIVES:

To study if the use of corticosteroids combined with surgery alleviates the damage to the nerve fibers in lumbar disc herniation.

SUMMARY OF BACKGROUND DATA:

The use of quantitative sensory testing can detect damage to the myelinated A-delta fibers (cold sense) and the unmyelinated C-fibers (warmth sense). Corticosteroids combined with surgery in lumbar disc surgery enhance the outcome after surgery in terms of less pain and more rapid rehabilitation.

METHODS:

Analyzing quantitative sensory testing before surgery and after 2 weeks and 2 years.

RESULTS:

In the corticosteroid group, we saw a statistically significant normalization for the warmth disturbance comparing with control group, which not was detected concerning the cold disturbance.

CONCLUSIONS:

The use of corticosteroids combined with surgery seems to protect some of the damage to the C-fibers in lumbar disc herniation.

Place, publisher, year, edition, pages
2005. Vol. 30, no 21, 2362-2368 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93724DOI: 10.1097/01.brs.0000184685.93424.f0PubMedID: 16261109OAI: oai:DiVA.org:uu-93724DiVA: diva2:167293
Available from: 2005-11-11 Created: 2005-11-11 Last updated: 2013-05-29Bibliographically approved
In thesis
1. Corticosteroids in Lumbar Disc Surgery
Open this publication in new window or tab >>Corticosteroids in Lumbar Disc Surgery
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In a prospective randomised double-blind study eighty patients with MRI verified lumbar disc herniation and corresponding clinical findings underwent microscopic disc removal. The patients were peroperatively given systemic and local corticosteroids or placebo, and followed for 2 years. The hospital stay and time to return to full-time work was significantly shorter in the treatment group. Pain measured as worst pain during the last week was also lower in the corticosteroid group. The results indicate that peroperative treatment with corticosteroids reduces pain and improves the functional outcome in patients operated for lumbar disc herniations.

To evaluate whether thermal quantitative sensory testing (QST) is applicable in the study of sensory dysfunction in lumbar disc herniations 66 patients with disc herniations underwent thermal QST. We found that thermal QST reflects sensory dysfunction in patients with lumbar disc herniations. However, thermal QST seems to have a poor predictive value for identifying the anatomic location of a herniated lumbar disc.

Quantitative sensory testing (QST) was used to detect damage to the myelinated A-delta fibres (cold sense) and the unmyelinated C-fibres (warmth sense). Corticosteroids combined with surgery in lumbar disc surgery improved the normalisation for the warmth disturbance compared to the control group.

A prospective analysis was performed on the predictive value of preoperatively determined lumbar lordosis and flexion for pain and disability in patients treated by microscopic lumbar disc surgery. Preoperative hyperlordosis correlated to more pain postoperatively (p=0.004). In patients with hypoflexion there was an association between hyperlordosis and moderate or severe pain postoperatively (p<0.001). The same outcomes were found for DRI. The stiff and straight back indicates a good outcome of lumbar disc surgery concerning pain and disability.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 31 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 84
Keyword
Surgery, lumbar disc heniation, corticosteroids, outcome, thermal quantitative sensory testing, QST, VAS, disability rating index, DRI, microscopic discectomy, Kirurgi
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-6126 (URN)91-554-6395-9 (ISBN)
Public defence
2005-12-02, Wilandersalen, M-huset, Universitetssjukhuset, Örebro, 13:15
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Supervisors
Available from: 2005-11-11 Created: 2005-11-11Bibliographically approved

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Nilsson, Olle

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