Epidural Fibrosis After Lumbar Disc Surgery: Prevention and Outcome Evaluation

Overview

Journal Asian Spine J

Date 2015 Jun 23

PMID 26097652

Citations 20

Authors

Mohamed M Mohi Eldin

Naglaa M Abdel Razek

Affiliations

Soon will be listed here.

Abstract

Study Design: This is a prospective, randomized, controlled study designed and conducted over 10 years from 2002 to 2012.

Purpose: The study aimed to monitor the effect of suction drains (SD) on the incidence of epidural fibrosis (EF) and to test, if the use of SD alone, SD with local steroids application, SD combined with fat grafts and local steroids application, or SD combined with fat grafts and without local steroids application, would improve outcome.

Overview Of Literature: EF contributes to significant unsatisfactory failed-back syndrome. Efforts have been tried to reduce postoperative EF, but none were ideal.

Methods: Between September 2002 and 2012, 290 patients with symptomatic unilateral or bilateral, single-level lumbar disc herniation were included in the study. Two groups were included, with 165 patients in group I (intervention group) and 125 patients in group II (control group). Group I was subdivided into four subgroups: group Ia (SD alone), group Ib (SD+fat graft), group Ic (SD+local steroids), and group Id (SD+fat graft+local steroids).

Results: The use of SD alone or combined with only fat grafts, fats grafts and local steroids application, or only local steroids application significantly improved patient outcome and significantly reduced EF as measured by magnetic resonance imaging (MRI).

Conclusions: This study has clearly demonstrated the fact that the use of suction drainage alone or combined with only fat grafts, fats grafts and local steroids application, or only local steroids application significantly improved patient outcome with respect to pain relief and functional outcome and significantly reduced EF as measured by an MRI. A simple grading system of EF on MRI was described.

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References

North R, Campbell J, James C, Wang H, Piantadosi S, Rybock J . Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation. Neurosurgery. 1991; 28(5):685-90; discussion 690-1. View

Eichholz K, Ryken T . Complications of revision spinal surgery. Neurosurg Focus. 2004; 15(3):E1. DOI: 10.3171/foc.2003.15.3.1. View

Aydin Y, Ziyal I, Duman H, Turkmen C, Basak M, Sahin Y . Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique. Surg Neurol. 2002; 57(1):5-13; discussion 13-4. DOI: 10.1016/s0090-3019(01)00677-2. View

LaRocca H, Macnab I . The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg Br. 1974; 56B(3):545-50. View

Dullerud R, Graver V, Haakonsen M, Haaland A, Loeb M, Magnaes B . Influence of fibrinolytic factors on scar formation after lumbar discectomy. A magnetic resonance imaging follow-up study with clinical correlation performed 7 years after surgery. Spine (Phila Pa 1976). 1998; 23(13):1464-9. DOI: 10.1097/00007632-199807010-00007. View

Kim S, Michelsen C . Revision surgery for failed back surgery syndrome. Spine (Phila Pa 1976). 1992; 17(8):957-60. DOI: 10.1097/00007632-199208000-00015. View

Llado A, Sologaistua E, Guimera J, Marin M . Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: a clinical study. Eur Spine J. 1999; 8(2):144-50. PMC: 3611140. DOI: 10.1007/s005860050145. View

Maroon J, Abla A, Bost J . Association between peridural scar and persistent low back pain after lumbar discectomy. Neurol Res. 1999; 21 Suppl 1:S43-6. DOI: 10.1080/01616412.1999.11741026. View

Anderson S, Racz G, Heavner J . Evolution of epidural lysis of adhesions. Pain Physician. 2006; 3(3):262-70. View

10.

Cervellini P, Curri D, Volpin L, Bernardi L, Pinna V, Benedetti A . Computed tomography of epidural fibrosis after discectomy: a comparison between symptomatic and asymptomatic patients. Neurosurgery. 1988; 23(6):710-3. DOI: 10.1227/00006123-198812000-00004. View

11.

Dogulu F, Kurt G, Emmez H, Erdem O, Memis L, Baykaner K . Topical mitomycin C-induced inhibition of postlaminectomy peridural fibrosis in rabbits. J Neurosurg. 2003; 99(1 Suppl):76-9. DOI: 10.3171/spi.2003.99.1.0076. View

12.

Ross J . Magnetic resonance assessment of the postoperative spine. Degenerative disc disease. Radiol Clin North Am. 1991; 29(4):793-808. View

13.

Jinkins J, Osborn A, Garrett Jr D, Hunt S, STORY J . Spinal nerve enhancement with Gd-DTPA: MR correlation with the postoperative lumbosacral spine. AJNR Am J Neuroradiol. 1993; 14(2):383-94. PMC: 8332936. View

14.

Park Y, Kim J, Chung H . Outcome analysis of patients after ligament-sparing microdiscectomy for lumbar disc herniation. Neurosurg Focus. 2005; 13(2):E4. DOI: 10.3171/foc.2002.13.2.5. View

15.

Manchikanti L, Rivera J, Pampati V, Damron K, McManus C, Brandon D . One day lumbar epidural adhesiolysis and hypertonic saline neurolysis in treatment of chronic low back pain: a randomized, double-blind trial. Pain Physician. 2006; 7(2):177-86. View

16.

Ross J, Obuchowski N, Modic M . MR evaluation of epidural fibrosis: proposed grading system with intra- and inter-observer variability. Neurol Res. 1999; 21 Suppl 1:S23-6. DOI: 10.1080/01616412.1999.11758604. View

17.

Sen O, Kizilkilic O, Aydin M, Yalcin O, Erdogan B, Cekinmez M . The role of closed-suction drainage in preventing epidural fibrosis and its correlation with a new grading system of epidural fibrosis on the basis of MRI. Eur Spine J. 2004; 14(4):409-14. PMC: 3489202. DOI: 10.1007/s00586-004-0801-6. View

18.

MAYFIELD F . Autologous fat transplants for the protection and repair of the spinal dura. Clin Neurosurg. 1980; 27:349-61. DOI: 10.1093/neurosurgery/27.cn_suppl_1.349. View

19.

Long D . Failed back surgery syndrome. Neurosurg Clin N Am. 1991; 2(4):899-919. View

20.

Fritsch E, Heisel J, Rupp S . The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine (Phila Pa 1976). 1996; 21(5):626-33. DOI: 10.1097/00007632-199603010-00017. View