Background  Steroid hormones are often used to relieve acute pain in patients after lumbar spine surgery because of their powerful anti-inflammatory effects. The two main clinical methods of administration are epidural topical administration and intravenous infusion, but their advantages and disadvantages and the population for which they are suitable are still debated.

  Objective  To compare the effectiveness and safety of topical steroids (betamethasone) and intravenous steroids (methylprednisolone sodium succinate) for postoperative pain relief and nerve root protection after minimal invasive posterior transforaminal lumbar interbody fusion (MIS-TLIF) of the lumbar spine.

  Methods  From January 2019 to June 2021, a retrospective analysis was performed in the medical records of patients undergoing MIS-TLIF surgery at the Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, patients with postoperative topical steroid hormone served as group A and patients with postoperative intravenous steroid hormone served as group B. The postoperative pain score (visual analogue scale, VAS), functional disability index (oswestry disability index, ODI), first time out of bed after surgery, perioperative blood glucose, bone density changes, postoperative radicular pain occurrence, and postoperative complications were compared between the two groups, and the perioperative effect of the two drug administration methods and the applicable population were evaluated.

  Results  Totally 192 patients were matched (1:1) by propensity score, including 96 patients in group A (28 males and 68 females, with a mean age of 53.9±8.5 years), and 96 patients in group B (36 males, and 60 females, with a mean age of 53.2±7.4 years). There was no significant difference in basic information between the two groups after matching. The Mean VAS scores in the group A were not significantly different from the group B on each day after surgery (all P>0.05). The mean getting out-of-bed time in group A was shorter than that in group B (25 h vs 27 h, P=0.034), and the incidence of radicular pain was significantly lower than that in group B at 3 months after surgery (11% vs 24%, P=0.023). Glucose values were significantly lower in diabetic patients in group B than those in group A on day 2 and 3 after medication (P＜0.05, respectively), and the proportion of female patients in group B who showed a decrease in bone mineral density after 3 months was significantly lower than that in the group A (5% vs 18%, P=0.023). No drug-related adverse reactions or complications occurred in both groups after surgery.

  Conclusion  The analgesic effects of the two dosing regimens are comparable, with topical steroids showing better nerve root protection, while diabetic and menopausal female patients benefit more from the use of intravenous steroids.