Methods: Retrospective cohort study. Objective: To determine the incidence and identify risk factors for radiculopathy requiring treatment with oral glucocorticoids within one month following lumbar microdiscectomy.

Background: Lumbar microdiscectomy (MD) often provides immediate relief of low back and leg pain; however, some patients experience recurrent postoperative radicular pain. While oral steroids are commonly used to manage this condition, the frequency of their use and associated risk factors remain unclear.

Methods: The PearlDiver national database was queried for patients who underwent lumbar MD for disc herniation. Patients were stratified based on whether they were prescribed oral steroids (Prednisone, Methylprednisolone, Prednisolone) from postoperative day 1 to day 30. Patient demographics and comorbidities were compared using Chi-squared analysis and Student's t-test. Multivariate logistic regression controlling for age, gender, Elixhauser Comorbidity Index (ECI), and the number of levels operated on was used to identify independent risk factors.

Results: Among 326,315 patients who underwent lumbar MD, 38,455 (11.78%) received oral steroids within 30 days postoperatively. Patients who received steroids were more likely to be female (51.88% vs. 46.70%) and have a higher ECI (3.04 vs. 2.71) (P<0.001). Independent risk factors included opioid use (OR: 2.10, [2.05-2.15]), far lateral disc herniation (OR: 1.37, [1.29-1.46]), female gender (OR: 1.23 [1.21-1.26]), prior epidural steroid injection (OR: 1.18, [1.15-1.21]), fibromyalgia (OR: 1.17, [1.13-1.20]), tobacco use (OR: 1.09, [1.08-1.13]), delaying surgery >90 days from disc herniation (OR: 1.14 [1.11-1.17]), depression (OR: 1.12 [1.09-1.15]), ECI (OR: 1.07, [1.06-1.071]), and revision MD (OR: 1.05, [1.01-1.09]) (all P<0.05).

Conclusions: This study found that 11.78% of patients undergoing lumbar MD require oral steroids postoperatively, reflecting a significant subset of patients with postoperative radiculopathy. Several patient- and procedural-related risk factors were identified. Further research is warranted to clarify the role of oral steroids and develop strategies to reduce postoperative radiculopathy.