Influence of Fibrinolytic Factors on Scar Formation After Lumbar Discectomy

Dullerud, R.; Graver, Vibeke; Haakonsen, Monika; Haaland, Alf Kristian; Loeb, Mitchell; Magnæs, B.

doi:10.1097/00007632-199807010-00007

Cited by 35 publications

(8 citation statements)

References 22 publications

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“…Although it is the most important cause for pain after the surgery, ongoing degenerative process in spine triggers the pain, with repeated secretion of cytokines and eventually causing more adhesions. There have been cases that presented with epidural scarring after 7 years of intervention also [ 16 17 ].…”

Section: Discussionmentioning

confidence: 99%

The outcome of epiduroscopy treatment in patients with chronic low back pain and radicular pain, operated or non-operated for lumbar disc herniation: a retrospective study in 88 patients

2018

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BackgroundPatients with lumbar disc herniation are treated with physiotherapy/medication and some with surgery. However, even after technically successful surgery some develop a failed back syndrome with persistent pain. Our aim was to evaluate the efficacy of epiduroscopy in patients who suffer chronic low back pain and/or radicular pain with or without surgery and the gender difference in outcome.MethodsA total of 88 patients were included with a mean age of 52 years (27-82), 54 women and 34 men. 66 of them were operated previously and 22 were non-operated. They all had persistent chronic back pain and radicular pain despite of medication and physical rehabilitation. Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) were evaluated preoperatively, after one month, six months and one-year after the epiduroscopy.Results All patients, and also the subgroups (gender and operated/non-operated) improved significantly in pain (VAS) and disability (ODI) at one month. A significant improvement was also seen at one year. No differences were found between men and woman at the different follow-up times. A slight worsening in VAS and ODI was noticed over time except for the non-operated group.ConclusionsEpiduroscopy helps to improve the back and leg pain due to lumbar disc herniation in the early stage. At one year an improvement still exists, and the non-operated group seems to benefit most of the procedure.

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Section: Discussionmentioning

confidence: 99%

The outcome of epiduroscopy treatment in patients with chronic low back pain and radicular pain, operated or non-operated for lumbar disc herniation: a retrospective study in 88 patients

2018

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“…Most synthetic materials that were studied as barriers were not effective, with unsatisfactory results and actually inviting more scarring and more complications compared with control groups. Autogenous barriers had better results, including fascia lata graft, pedicled grafts, and free fat grafts [568181923242627]. …”

Section: Discussionmentioning

confidence: 99%

Epidural Fibrosis after Lumbar Disc Surgery: Prevention and Outcome Evaluation

Eldin

Razek

2015

Asian Spine J

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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.

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“…R. Dullerud et al [12,28] оценивали фибрионолитическую активность крови до операции и пришли к выводу, что исход заживления послеопе-рационной раны зависит от размеров хирургического воздействия и некоторых фибринолитических факто-ров, которые связаны с плохим клиническим исходом и более выраженным эпидуральным фиброзом по данным МРТ. Это стало основой разработки способа дооперационного прогнозирования развития эпиду-рального фиброза [12].…”

Section: Neurology and Neurosurgeryunclassified