Prevention of epidural scarring after microdiscectomy: a randomized clinical trial comparing gel and expanded polytetrafluoroethylene membrane

Abstract

A randomized clinical trial compared two materials used to prevent epidural scarring after microdiscectomy. To determine whether ADCON-L Gel (ALG) or Preclude Spinal Membrane (PSM) was more effective in preventing scarring, reducing pain, and improving quality of life postoperatively. Postdiscectomy syndrome may result from epidural scarring. Various materials have been used in attempts to prevent this problem, but none have provided optimal results. Previous laboratory and clinical studies have found ALG and PSM to be effective, but none compared the two materials. Thirty-one patients undergoing primary microdiscectomy were randomly assigned to receive either ALG or PSM. Postoperatively, patients were evaluated by magnetic resonance imaging (MRI), with contrast, for volume and rostral-caudal extent of scar tissue and nerve root involvement. Back and leg pain and quality of life were assessed by neurologic examinations and standardized patient surveys. Findings at any reoperations were recorded. Results in the PSM (n = 18) and ALG (n = 13) groups were compared statistically. No operative or postoperative complications occurred. Two patients in each group required reoperation. MRI at 6 months showed no, mild or mild-moderate scarring in most patients, with no significant differences between the ALG and PSM groups in scar volume and extent or nerve root involvement. Neurologic examinations and patient surveys showed substantial reductions in pain over time in both groups but no significant differences between groups. PSM was easy to see and remove at reoperation. PSM and ALG are equally effective in preventing epidural scarring associated with postdiscectomy syndrome.

To what extent topical application of cova™ and tisseel® cause spinal peridural fibrosis? comparison with adcon® gel: an experimental study in rat model.

“…Many factors play a role in amount of peridural scar formation such as postoperative hematoma, postoperative infection and surgical techniques. Improved minimally invasive surgery techniques, many agents and mechanical barriers have been used to accomplish this bothering problem (5,6,12,14,15,17,19,26,(29)(30)(31)33).…”

“…There was no grade 0 in the laminectomy group. (4,6,8,11,12,14,20,(29)(30)(31). Actually, PF is a healing process after surgery and it occurs to some degree in response to Samples of histopathological sections for grade 1 (HE stain sample of grade 1 fibrosis) and grade 2 (MT stain sample of grade 2 fibrosis) are demonstrated in Figure 1 and Figure 2.…”

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

“…2,3,9,[17][18][19]21,25,26,28,33,36,[41][42][43]45,49,[52][53][54][56][57][58]61 MED techniques employ a longitudinal paramedian incision through which a tubular retractor is placed and visualization is achieved through an endoscope. 2,6,10,13,19,24,25,29,36,46,51,53,57,60,62,64 Percutaneous discectomy entails placing a sheath directly into the disc space via a transforaminal approach, extraforaminal approach, or interlaminar approach and then using a suction/debrider or chemical injection to remove the disc.…”

Mittelfristige Ergebnisse nach Fusionsoperationen bei isthmischer Spondylolisthese und deren Auswirkung auf die Arbeitsfähigkeit

“…Dies darf jedoch nicht darüber hinwegtäuschen, dass es sich bei den durchgeführten Operationen um große und durchaus risikoreiche Operationen an der Wirbelsäule [9,[18][19][20][21] handelt. Die Operation muss sicherlich genau überdacht werden und mit den Patienten sollte schon vor der Operation bezüglich der Chancen, Alternativen und Komplikationen eine genaue Aufklärung durchgeführt werden.…”