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| Original  |  Article | 

Early outcome of radiculopathy with local application of steroid in 

perineural space in lumbar discectomy

Mohammad Farid Raihan, Asifur Rahman, Abu Saleh Mohammad Abu Obaida,  Md Shahnawaz 

Bari, Md Atikur Rahman, Hafiz Asif Raihan, Olinur Razib, Mohammad Kamruzzaman Bhuiyan, 

Md Jaynul Islam, Mirza Hafizur Rashid, Mohammad Hossain

Introduction

Lumbar discectomy is effective in improving 

pain, quality of life and function in patients 

with lumbar intervertebral disc herniation 

and radiculopathy.1 However, in the 

immediate postoperative period, many 

patients experience low back pain, 

radiculopathy, delayed rehabilitation and 

hospital discharge.1,2  The commonly used 

and well-established strategies to treat 

postoperative pain include analgesics, both 

NSAIDs and opioids in oral or injectable 

forms.3 Nowadays, the application of 

anaesthetics in peri-neural space is becoming 

a new modality to reduce radicular pain. 

After discectomy and before the closure of the 

wound, a corticosteroid solution is applied 

around the nerve root that has been 

decompressed. The rationale for this is that 

steroid reduces local inflammation around 

the neural elements; this, in turn, reduces the 

Article Info Abstract

Department of Neurosurgery, BSMMU, 

Dhaka (MFR, AR, ASMAO, MSB, MAR, OR, 

MH); Department of Neurosurgery, MAG 

Osmani Medical College, Sylhet (HAR); 

Department of Physical Medicine and 

Rehabilita�on, BSMMU, Dhaka(MKB);  

Department of Neurosurgery, Na�onal 

Ins�tute of Neuro Science & Hospital, 

Dhaka(MJI, MHR)

For Correspondence:  

Mohammad Farid Raihan

Email: faridraihan8@gmail.com

Cite this ar�cle: 

Raihan MF, Rahman A, Obaida ASMA,  

Bari MS, Rahman MA, Raihan HA,                      

Razib O, Bhuiyan MK, Islam MJ, Rashid 

MH, Hossain M. Early outcome of                               

radiculopathy with local applica�on of 

steroid in perineural space in lumbar 

discectomy.  Bangabandhu  Sheikh  Mujib 

Med Univ J. 2022; 15(2): 107-110. 

Copyright:  

The  copyright  of  this  ar�cle  is  retained 

by the author(s) [Atribu�on CC-By 4.0]   

Available at: 

www.banglajol.info  

A Journal of Bangabandhu Sheikh Mujib 

Medical University, Dhaka, Bangladesh 

Lumbar disc herniation resulting in compression and inflammation of nerve roots causes low 
back pain and radiculopathy. Per-operative use of steroids may help reduce inflammatory 
reaction and scar formation, causing less postoperative pain. The study aimed to assess the 
early outcome of radiculopathy with local application of steroids in peri-neural space after 
lumbar discectomy. This experimental study was carried out in the Department of 
Neurosurgery of the National Institute of Neuroscience and Hospital (NINS&H), Dhaka from 
March 2019 to August 2020. A total of 68 patients operated for prolapsed lumbar 
intervertebral disc (PLID) at L4/L5 and /or L5/S1 levels were divided into two groups. 
Patients who did not receive steroids (n=34) and those who received steroids (n=34) in 
peri-neural space were considered group A and group B, respectively. Patients were 
examined on the 1st, 2nd and 14th postoperative days to measure the pain intensity by the 
Visual Analogue Scale (VAS). Pre-operatively mean (standard deviation, sd) VAS was 7.41 
(1.28) in Group A and 7.91 (0.9) in Group B (p-value >.05). Mean (sd) improvement of pain 
intensity on day 1, was 58.82 (17.55)% in Group A and 70.59 (12.26)% in Group B from 
pre-operative VAS. On day 2, 71.69 (12.43)% improvement was seen in Group A and 79.78 
(9.74)% in Group B. On day 14, 75.37 (9.96)% improvement was seen in Group A and 83.46 
(7.36)% in Group B from pre-operative. The improvements of VAS in all 1st, 2nd and 14th 
days were statistically significant (p-value <.05) between the two groups. Local application of 
steroids in peri-neural space found effective in reducing early postoperative radiculopathy 
following lumbar discectomy.

Received               : 12 February 2022 

Accepted              :  22 March 2022 

Available Online  :  15 May 2022

ISSN: 2224-7750 (Online)          

 2074-2908 (Print)  

DOI: h!ps://doi.org/10.3329/bsmmuj.v15i2.60864

Keywords: Lumbar disc hernia�on,radic-

ulopathy, low back pain

pain experienced by the patient. However, the 

use of intraoperative epidural corticosteroids 

is debatable.5-6 So, we aimed to access the 

early outcome of radiculopathy following 

lumbar discectomy, a common surgery in 

Bangladesh with the local application of 

steroids in peri-neural space.

Methods

This experimental study was carried out on 68 

patients diagnosed with prolapse lumbar 

intervertebral disc (PLID) at L4/L5 and/or 

L5/S1 levels in the Department of Neurosur-

gery of National Institute of Neuroscience 

and Hospital (NINS&H), Dhaka, Bangladesh 

from March 2019 to August 2020. Ethical 

clearance for the study was taken from the 

Department of Neurosurgery and IRB, 

NINS&H and informed written consent was 

taken from each patient. Pre-operative          



108 BSMMU J 2022; 15(2): 107 - 110

Distribution of the study patients by age (n=68)

Age (years) Non-Steroid Steroid p value

 Group A Group B 

 (n=34) (n=34) 

 n % n % 

≤30 6 17.4 7 20.5 

31-40 14 40.9 15 44.1 

41-50 9 26.4 7 20.5 

51-60 5 14.6 5 14.6 

Mean±SD                 39.59±11.17                 39.74±10.43 0.912ns

Table-I

Distribution of the study patients by sex (n=68)

Sex Non-Steroid Steroid p value

 Group A Group B 

 (n=34) (n=34) 

 n % N % 

Male 21 61.8 21 61.8 1.000ns

Female 13 38.2 13 38.2 

Table-II

neurological examinations were done. The patients were 

divided equally into group A and group B, each having 34 

patients based on local application of steroids in peri-neural 

space following discectomy. Surgery was carried out without 

local application of steroids in Group A and with the local 

application of steroids in Group B. Patients were re-examined 

on the 1st, 2nd and 14th post-operative days to measure the 

intensity of radicular pain. Following meticulous haemostasis, 

40 mg of methylprednisolone acetate was given around the 

decompressed nerve root in group B (steroid group). In group 

A (non-steroid group), nothing was given, and the wound was 

closed in a standard procedure. Postoperatively, patients of 

both groups were assessed by VAS score and recorded on the 

1st, 2nd and 14th postoperative days. 

The pain intensity was graded from 0 (no pain) to 10 (the most 

severe pain). The VAS scores between the groups were 

compared using an unpaired t-test. Statistical analysis was 

carried out using the Statistical Package for Social Sciences 

(SPSS INC Chicago, Illinois, USA) version 25.0 for windows. A 

descriptive analysis was performed for all data. A p-value <.05 

was considered statistically significant.

Results

Table-I shows the distribution of the study patients by age. It 

was observed that more than one-third (40.9%) of the patients 

belonged to age 31-40 years in Group A and 15(44.1%) in 

Group B. The mean (sd) age was 39.59 (11.17) years in Group 

A and 39.74 (10.43) in Group B (p-value >.05). 

Table - II shows the distribution of the study patients by sex. It 

was observed that almost two-two-thirds (61.8%) of patients were 

male in both Group A and Group B (p-value >.05). 

It was observed that the mean (sd) VAS was 7.41 (1.28) in Group 

A and 7.91(0.9) in Group B before the operation. On the 1st day, 

mean (sd) VAS was 3.29 (1.4) in Group A and 2.35 (0.98) in 

Group B. Similarly, on the 2nd day, mean (sd) VAS was 2.26 

(0.99) in Group A and 1.62 (0.78) in Group B. In addition, on the 

14th day, mean (sd) VAS was 1.97 (0.8) in Group A and 1.32 

Figure 2: Line chart showing the distribution of the study patients 

according to VAS

(0.59) in Group B, which were a significant decline from 

pre-operative in both groups in all follow-up but more decline 

in Group B. On the other hand, the mean percentage of VAS 

improvement on day 1 from the preoperative period was 

58.82±17.55% in Group A and 70.59±12.26% in Group B. The 

mean percentage of VAS improvement on day 2 from the 

preoperative period was 71.69±12.43% in Group A and 

79.78±9.74% in Group B. The mean percentage of VAS 

improvement at day 14 from the preoperative period was 

75.37±9.96 and 83.46±7.36 in Group A and Group B, 

respectively. The mean percentage of VAS improvement on a 

postoperative day 1st, day 2nd and day 14th were statistically 

significant (p<0.05) in Group B, which indicates that the 

application of steroids in peri-neural space reduced early 

postoperative pain following lumbar discectomy. 

0

1

2

3

4

5

6

7

8

9

Pre-operative Day 1 Day 2 Day 14th

M
e

a
n

VAS

Group I

Group II



BSMMU J 2022; 15(2): 107 - 110 109

Distribution of the study patients according to visual analogue scale preoperative and postoperative day 1, day 2 and day 
14 (N=68)

VAS Group A (n=34) Group B (n=34) p-value 

 Mean±SD Mean±SD 

Pre-operative VAS 7.41±1.28 7.91±0.9 0.067ns

Postoperative VAS (day 1) 3.29±1.4 2.35±0.98 0.002s

% of improvement from Pre-operative VAS 58.82±17.55 70.59±12.26 0.001s

Postoperative VAS (day 2) 2.26±0.99 1.62±0.78 0.004s

% of improvement from Pre-operative VAS 71.69±12.43 79.78±9.74 0.001s

Postoperative VAS (day 14)  1.97±0.8 1.32±0.59 0.001s

% of improvement from Pre-operative VAS 75.37±9.96 83.46±7.36 0.001s

s=significant, ns=not significant, p value reached from unpaired t-test 

Table-III

Discussion

The incidence of lumbosacral radiculopathy is estimated to be 

approximately 3–5%.6,7 The prolapsed lumbar intervertebral 

disc is one of people's most common vertebral column 

diseases leading to back pain, radicular pain, and neurological 

deficit due to nerve root compression.8 Intraoperative 

epidural steroids have been used as adjuvant pain therapy in 

lumbar disc surgery. They reduce postoperative pain by 

suppressing mediators of inflammation.9 Thus, the use of 

steroids reduces postoperative pain by minimizing the early 

inflammatory reaction and helps in less scar tissue formation, 

ultimately reducing hospital stay, back pain radicular pain 

and neurological deficits.8 The age and gender distribution of 

the present study are compatible to the other previous 

studies.9 

In this current study, it was observed that the mean 

percentage of VAS improvement on postoperative days 1, 2 

and 14 were significantly (p<0.05) more in Group B, which 

indicates that the application of steroids in peri-neural space 

reduced early postoperative radicular pain following lumbar 

discectomy. Preoperative VAS scores between the two groups 

were not statistically significant (p>0.05). Postoperatively on 

day 1, VAS scores were 3.29 and 2.35; on day 2, it was 2.26 and 

1.62; and on day 14, is was 1.97 and 1.32 for control and steroid 

groups, respectively, suggesting significant relief in back pain 

and radiculopathy compared to preoperative status. 

However, there was a statistically significant difference in 

VAS score on day 1 (p=0.002), day 2(p=.004) and day 

14(p=.001) postoperatively when comparing group A and 

group B. The pain level can be communicated through a visual 

analogue scale.9 A low dose of methylprednisolone (40 mg), 

which was left on the decompressed nerve root, was found to 

be able to decrease the intensity of the immediate 

postoperative radicular pain and also found statistically 

significant in the first and second postoperative days and in 

the sixth to twelfth days. Steroids administered epidurally in 

patients with disc hernia were also found to provide 

significant radicular pain relief postoperatively in 78% of the 

patients.10

Studies found that epidural methylprednisolone during 

lumbar discectomy reduced hospital stay, recovery time, leg 

pain, and neurological deficits. There were no side effects of 

epidural methylprednisolone in the 2-year follow-up period.5 

Oedema and inflammation of the nerve root or dorsal root 

ganglions and handling of the nerve root are responsible for 

creating uncomfortable situations for many patients and may 

increase the postoperative requirement of anti-inflammatory 

analgesics or morphine derivatives and expose the patient to 

adverse effects related to these medicines.9 Radicular pain 

following disc surgery is related to a number of factors that 

include the inflammatory cascade which is triggered by tissue 

trauma and direct manipulation of the nerve root. It is thought 

that using steroids reduces postoperative pain by suppressing 

mediators of pain and inflammation such as prostaglandins, 

leukotrienes, bradykinin and histamine.5

Conclusion 

It can be concluded that the local application of steroids in 

peri-neural space reduces immediate postoperative pain 

effectively. 


