BLOCKING THE PAIN TO BOOST THE GAIN: STEROID SHOT OR NOT BEFORE LUMBAR SURGERY?

Preoperative nerve root block (NRB), with or without steroid, is used to treat neuropathic leg pain before lumbar surgery. We assessed its association with postoperative patient-reported outcome measures (PROMs) and complications.

This study was a retrospective review of prospectively collected data from patients undergoing elective lumbar surgery between 2020 and 2024. The prospectively collected dataset included pre- and postoperative visual analogue scale (VAS) scores for back and leg pain, EQ-5D-5L index and EQ VAS. Complications were also recorded. Patients were stratified into no NRB, steroid NRB and local-anaesthetic-only NRB groups, and outcomes were compared using the Kruskal-Wallis test.

Of 581 patients undergoing lumbar discectomy, decompression or fusion surgery, 201 were excluded because of incomplete PROMs, leaving 380 patients with complete pre- and postoperative data. Their median age was 61 years (16 to 86); 55% were male. Procedures comprised decompression alone in 180 patients (47%), primary microdiscectomy in 125 (33%) and fusion with decompression in 75 (20%). Overall, 235 patients (62%) received no NRB and 145 (38%) received NRB: 103 (71%) with steroid and 42 (29%) with local anaesthetic alone. Improvements in VAS back pain, VAS leg pain and EQ VAS were similar among groups (p = 0.436, p = 0.663 and p = 0.073, respectively). Median EQ-5D-5L index scores were 0.617 without NRB, 0.685 following steroid NRB and 0.728 following local-anaesthetic-only NRB, representing a significant difference (p = 0.034). There were 52 complications among 380 patients (14%), with no significant difference between groups (p = 0.585).

Pain outcomes were equivalent regardless of previous NRB. Patients receiving NRB had higher EQ-5D-5L index scores, greatest following local anaesthetic alone. Preoperative NRB was not associated with increased complications.