Epidural Steroid Facet Joint Injections Augment the Outcomes of Percutaneous Lumbar Spinal Fixation for Post-discectomy Failed Surgery through Local Immunomodulation

Background: Surgical management of spinal disc disease is still questionable due to the high incidence of recurrence of pain and disability. Aim of the study: Evaluation of the outcomes of combined screw and rod spinal fixation with epidural steroid injection versus spinal fixation only.
Patients and Methods: Patients previously had back surgery, and presented with recurrent, persistent, or exaggerated back pain with increased disability and disturbed quality of life, drew preoperative blood samples for ELISA estimation of serum levels of tumor necrosis factor-α (TNF-α), and interleukins (IL) 1β, 6, and 10. These biomarkers were re-estimated at 6 months after surgery. Patients were divided into two groups: Group A received spinal fixation alone, and Group B received the combined procedure.
Results: At 6 months after surgical correction, the assessments of clinical scoring and serum inflammatory markers improved markedly, and the immune milieu disturbances were adjusted relative to the preoperative status. These changes were markedly evident in patients who received the combined procedures compared to those who received fixation only. Additionally, the extent of change in the estimated levels of serum biomarkers positively correlated with that reported in clinical scores.
Conclusion: The applied synchronous spinal fixation and epidural injection therapy ensured to be an effective procedure for the mitigation of the recurrent, persistent, or exacerbated manifestations of failed back surgery. This effect outperformed the effects of spinal fixation alone. The noticed better performance of the combined therapy might be attributed to the remodulation of the detected immune deregulation.