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 steroids in the cause of these abscesses is discussed, and a review the literature concerning its value is provided. Objective. To evaluate experiences with the efficacy and safety of perioperative methylprednisolone. Summary of Background Data. No previous study has described a high infection rate with the use of epidural methylprednisolone. The literature supporting epidural steroids is equivocal, and reports supporting their perioperative use are scant. Methods. In an 8-month period, 31 patients received 1 mL (40 mg) epidural methylprednisolone at the conclusion of microdiscectomy. Therapy was discontinued after an increased postoperative deep infection rate was noted. Results in these patients were compared with those in more than 400 others who did not receive intraoperative steroids during a 7-year period. Results. In the steroid group, three epidural abscesses,were encountered. There were no deep infections in the nonsteroid group. Conclusion. The use of perioperative epidural methylprednisolone in the currently reported cases was associated with three incidences of infection. A prospective study is needed to examine its use.