Effects of dexamethasone combined with vitamin B12 on percutaneous endoscopic interlaminar discectomy early outcomes: a randomized controlled trial.

IF 2.8 3区医学 Q1 ORTHOPEDICS Journal of Orthopaedic Surgery and Research Pub Date : 2024-11-07 DOI:10.1186/s13018-024-05210-z

Cheng He, Jianhua Li, Wei Hu, Bo Xiao, Tuoying Fan, Jiangjun Zhou, Feng Shuang, Hao Li

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Abstract

Background: Residual low back and leg pain can occur after percutaneous endoscopic interlaminar discectomy (PEID) and compromise early surgical outcomes. This study aimed to determine the efficacy of combining dexamethasone with vitamin B12 (VB12) via epidural injection in improving the symptoms of low back and leg pain after PEID, and the underlying mechanism of action.

Methods: Patients who underwent PEID for lumbar disc herniation (LDH) were enrolled and randomly assigned to the single surgery (SS) group, where disc removal was performed via PEID alone, or the combined treatment (CT) group, which received epidural injections of dexamethasone and VB12 alongside surgery. The outcome measures were the Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), serum inflammatory factor expression, adverse surgical events, duration of postoperative hospitalization, and modified MacNab criteria.

Results: Compared with the SS group, the CT group exhibited lower VAS scores for low back and leg pain at 1, 3, and 7 days post-surgery (P < 0.05). JOA and ODI scores were significantly improved in the CT group than in the SS group 7 days post-surgery (P < 0.05); however, no significant differences were observed at other time points. Serum inflammatory factors were lower in the CT group than in the SS group 3 days post-surgery (P < 0.05). The duration of postoperative hospitalization was shorter in the CT group (P < 0.05). Both groups had similar good outcomes (89.3% vs. 92.2%, P = 0.945).

Conclusions: Epidural injection of dexamethasone and VB12 effectively reduces early postoperative low back and leg pain, lowers postoperative inflammatory factor expression, and improves early PEID outcomes. Its clinical adoption merits consideration.

Trial registration: This trial was registered with the China Clinical Trial Registration Center (Identifier: ChiCTR2400088854).

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地塞米松联合维生素B12对经皮内窥镜椎间盘切除术早期疗效的影响：随机对照试验。

背景：经皮内镜椎间盘切除术（PEID）后可能会出现腰腿痛残留，影响早期手术效果。本研究旨在确定硬膜外注射地塞米松和维生素 B12（VB12）对改善腰椎间盘突出症（PEID）术后腰腿痛症状的疗效及其作用机制：方法：对腰椎间盘突出症（LDH）患者进行腰椎间盘突出症手术（PEID），并将其随机分配到单一手术（SS）组（仅通过腰椎间盘突出症手术进行椎间盘切除）和联合治疗（CT）组（在手术的同时进行硬膜外注射地塞米松和维生素B12）。结果测量包括视觉模拟量表（VAS）、日本骨科协会（JOA）评分、Oswestry残疾指数（ODI）、血清炎症因子表达、手术不良事件、术后住院时间和改良MacNab标准：与 SS 组相比，CT 组在术后 1 天、3 天和 7 天的腰痛和腿痛 VAS 评分较低（P 结论：CT 组的腰痛和腿痛 VAS 评分低于 SS 组（P）：硬膜外注射地塞米松和 VB12 能有效减轻术后早期腰腿痛，降低术后炎症因子表达，改善 PEID 早期预后。试验注册：本试验已在中国临床试验注册中心注册（注册号：ChiCTR2400088854）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.