Use of epidural steroids after discectomy may predispose to infection

Study Design. This is a report of three cases of epidural abscess occurring after use of intraoperative epidural methylprednisolone in 31 patients who had undergone lumbar microdiscectomy. The possible role of epidural steroi ds in the cause of these abscesses is discussed, and a review the literatur e concerning its value is provided. Objective. To evaluate experiences with the efficacy and safety of perioper ative methylprednisolone. Summary of Background Data. No previous study has described a high infectio n rate with the use of epidural methylprednisolone. The literature supporti ng epidural steroids is equivocal, and reports supporting their perioperati ve use are scant. Methods. In an 8-month period, 31 patients received 1 mL (40 mg) epidural m ethylprednisolone at the conclusion of microdiscectomy. Therapy was discont inued after an increased postoperative deep infection rate was noted. Resul ts in these patients were compared with those in more than 400 others who d id not receive intraoperative steroids during a 7-year period. Results. In the steroid group, three epidural abscesses,were encountered. T here were no deep infections in the nonsteroid group. Conclusion. The use of perioperative epidural methylprednisolone in the cur rently reported cases was associated with three incidences of infection. A prospective study is needed to examine its use.