Epidural Fibrosis after Lumbar Disc Surgery: Prevention and Outcome Evaluation

Abstract

Study DesignThis is a prospective, randomized, controlled study designed and conducted over 10 years from 2002 to 2012.PurposeThe 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 LiteratureEF contributes to significant unsatisfactory failed-back syndrome. Efforts have been tried to reduce postoperative EF, but none were ideal.MethodsBetween 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).ResultsThe 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).ConclusionsThis 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.

Modern Ideas About Epidural Fibrosis (Literature Review)

“…Имеется ряд публикаций, где авторы предложили исполь-зовать во время операции гемостатики [34], среди которых лучшим признан TachoComb. Некоторые авторы используют активные дренажи, эпидураль-ные катетеры и ирригаторы в послеоперационном периоде с целью дренирования послеоперационной раны и позвоночного канала [2,42].…”

Magnetic resonance imaging of the spinal epidural space

“…Epiduralna fibroza je očekivana posljedica operacije hernijacije diska i oblik je normalnih reparativnih mehanizama 7 . Iako je udružena s 10 % do 24 % slučajeva operativnog zahvata kralježnice s lošim ishodom (engl.…”

“…Failed Back Surgery Syndrom -FBSS) kontroverzan je odnos između epiduralne fibroze i trajnih bolova u leđima ili radikularnih bolova kod pacijenata nakon operativnog zahvata na kralježnici 8 . Pojedine studije pokazale su da bolesnici s ekstenzivnom epiduralnom fibrozom imaju 3,2 puta češću pojavu rekurentnih radikularnih bolova, dok druge studije ne nalaze poveznicu operacijska tehnika s najmanjim mogućim krvarenjem smanjuje mogućnost formiranja ožiljka 7 . U velikom broju studija prezentiraju se metode korištenja različitih materijala s ciljem sprječavanja stvaranja epiduralnog ožiljnog tkiva, kao što su autologno masno tkivo ili različiti sintetski materijali 8 .…”

“…U velikom broju studija prezentiraju se metode korištenja različitih materijala s ciljem sprječavanja stvaranja epiduralnog ožiljnog tkiva, kao što su autologno masno tkivo ili različiti sintetski materijali 8 . Ožiljak se identificira na T1 mjerenim slikama kao formacija nižeg signala u odnosu na materijal diska, što ga obično razlikuje od svježe rehernijacije diska, a razlikuje se i od okolnog epiduralnog masnog tkiva koje je višeg signala 7 . Nakon nekog vremena dolazi do deformacije duralne vreće uslijed njene retrakcije prema ožiljnom tkivu.…”

Salvianolic acid B reduced the formation of epidural fibrosis in an experimental rat model

“…Many attempts have been conducted at both the clinical and experimental levels [8–10]. However, none of these efforts have resulted in successful clinical application.…”