Recurrent pain after lumbar discectomy: the diagnostic value of peridural scar on MRI

Vogelsang, Jens P.; Finkenstaedt, Michael; Vogelsang, Monika; Markakis, E.

doi:10.1007/s005860050208

Cited by 44 publications

(26 citation statements)

References 40 publications

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“…These factors include misdiagnosis, technical failure, new disc protrusion, bony compression, excessive fibrosis, facet syndrome, infection and instability 7,[22][23][24] . In a retrospective study Osterman et al 25 found a risk of 25,1% of further spinal surgery in the first ten years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Almeida

Poletto

Milano

et al. 2007

Arq. Neuro-Psiquiatr.

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-Lumbar disc herniation (LDH) is a common cause of back and sciatic pain. When clinical treatment fails, surgery may be indicated in selected patients. Although surgery is effective in most cases, some of these patients may have a poor outcome. Different factors may influence these results and poor adaptation at work is one well-known cause of treatment failure. This study examines 350 patients on longterm follow-up after surgery for first-time LDH. The relationship was analyzed between occupation before surgery and outcome (maintenance of lumbar and leg pain, satisfaction with the surgical treatment and return to work). The preoperative occupation (employed in public or private services, autonomous, unemployed, housewife, retired or student) and the exertion at work were analyzed as prognostic factors for different clinical outcomes. Although unemployed people had higher numerical analog scale for lumbar pain and retired patients had a higher leg pain, this difference was not statistically significant. Retired people were significantly less satisfied with the surgical result. Higher exertion at work showed a statistically insignificant higher level of pain and lower degree of satisfaction. The authors conclude that preoperative occupation was not a statistically significant factor in this series of patients.KEY WORDS: lumbar disc herniation, occupation, failed back syndrome, outcome, discectomy.Cirurgia de hérnia de disco lombar: existe relação entre a profissão e a persistência de dor?RESUMO -A hérnia de disco lombar (HDL) é uma causa comum de dor lombar e ciática. Quando o tratamento clínico não oferece melhora dos sintomas, a cirurgia pode ser proposta em casos selecionados. Apesar de ser efetiva, uma pequena, porém significativa parcela dos pacientes operados podem não melhorar. Diversos fatores podem influenciar tais resultados. A insatisfação no ambiente de trabalho é relacionada com um maior índice de maus resultados. Neste estudo, 350 pacientes no pós-operatório tardio da primeira cirurgia de HDL foram estudados, analisando a possível relação entre tipo de profissão antes da cirurgia e evolução clínica (persistência de dor lombar e em membro inferior, satisfação com a cirurgia e retorno ao trabalho). Os pacientes foram classificados quanto à profissão em empregados públicos, empregados em órgãos privados, autônomos, desempregados, donas de casa, aposentados e estudantes. Também o grau de esforço no ambiente de trabalho foi analisado como fator prognóstico. Os desempregados relataram índices de dor lombar maiores e os aposentados tiveram maiores índices de dor irradiada, apesar de que estatisticamente os valores não foram significativos. Os aposentados ficaram significativamente menos satisfeitos com o tratamento no longo prazo. Um maior esforço no ambiente de trabalho não se correlacionou estatisticamente com o grau de dor e satisfação. Concluimos que o tipo de profissão não foi fator estatisticamente significativo na evolução destes pacientes. Os aposentados tiveram menor grau de satisfação co...

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Section: Discussionmentioning

confidence: 99%

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Almeida

Poletto

Milano

et al. 2007

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…The conclusion that the extent of peridural scarring defined by MRI is of minor value in patients with recurrent back and leg pain after lumbar microdiscectomy is further agreed upon in a number of recent studies [1,6,33].…”

Section: Discussionmentioning

confidence: 78%

“…Early detected epidural tissue on MRI can be due to postoperative haematoma and may develop to epidural scar tissue [4]. Because of the normal changes before 6 months after surgery there is risk of misinterpretations [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients

et al. 2008

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A prospective randomised 2-year follow-up study on patients undergoing lumbar disc herniation surgery. The objective was to investigate the relationship between peridural scarring and clinical outcome, the scar development 6 and 24 months postoperatively by using MRI, and if ADCON-L (a bioresorbable carbohydrate polymer gel) has an effect on scar size and/or improve patients' outcome after lumbar disc herniation surgery. The association between peridural scarring and recurrent pain after lumbar disc herniation surgery is debated. Numerous materials have been used in attempts to prevent or reduce postoperative peridural scarring; however, there are conflicting data regarding the clinical effects. The study included 119 patients whose mean age was 39 years (18-66); 51 (47%) were women. Sixty patients (56%) were perioperatively randomised to receive ADCON-L, and 48 (44%) served as controls. All patients underwent MRI at 6 and 24 months postoperatively, and an independent radiologist graded the size, location and development of the scar, by using a previously described scoring system. Preand 2-year postoperatively patients graded their leg pain on a visual analogue scale (VAS). At the 2-year follow-up patients rated their satisfaction with treatment (subjective outcome) and were evaluated by an independent neurologist (objective outcome), using MacNab score. There was no relationship between size or localisation of the scar and any of the clinical outcomes (VAS, subjective and objective outcome). The scar size decreased between 6 and 24 months in 49%, was unchanged in 42% and increased in 9% of the patients. Patients treated with ADCON-L did not demonstrate any adverse effects, nor did they demonstrate less scarring or better clinical outcome than control patients. No significant association between the presence of extensive peridural scar or localisation of scar formation and clinical outcome could be detected in the present study. Further, no positive or negative effects of ADCON-L used in disc herniation surgery could be seen.

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“…It behaves as a reparative inflammation causing clinical problems of characteristic nature (5,32,51,52). Epidural fibrosis affects the normal neural dynamics of nerve root by producing adhesions tethering the nerve root to adjacent tissues.…”

Section: Discussionmentioning

confidence: 99%

Prevention of epidural fibrosis in rats by local or systemic administration of citicoline

Savran¹,

Bekâr²,

Cansev³

et al. 2012

Turkish Neurosurgery

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AIm: The objective of this study was to investigate the effect of citicoline administration on epidural fibrosis which is a frequent complication of lumbar disc surgery with no effective treatment or preventive surgical technique. mATeRIAL and meTHods: Sixty Sprague-Dawley female rats undergoing L4-5 right hemilaminotomy and annular fenestration were arranged in three groups: rats in Group 1 (control group) and Group 2 (topical citicoline group) were applied 0,9% saline and 100 µM citicoline on surgical area, respectively, while rats in Group 3 (systemic citicoline group) received 600 µmol/kg citicoline intraperitoneally. Rats were sacrificed four weeks later and their vertebral colons were removed en bloc. Groups were evaluated according to histological criteria and results were compared using statistical tools. ResuLTs:Compared with control group, significantly less epidural fibrosis, dural adhesion, fibroblast cell density, foreign body reaction, and medulla spinalis retraction were observed in groups treated with topical and systemic citicoline (groups 2 and 3) (p<0,001). No significant difference was found with regard to measured parameters between two treatment groups (p>0,05). CoNCLusIoN:Our study demonstrates for the first time in the literature that citicoline may be effective for preventing postoperative epidural fibrosis. However, its mechanism of action and clinical effectiveness must be further investigated.KeywoRds: Epidural fibrosis, Annular fenestration, Laminatomy, Citicoline, Rat ÖZ AmAÇ: Çalışmamızın amacı, sitikolin uygulamasının henüz efektif bir tedavisi veya koruyucu bir cerrahi tekniği bulunmayan ve lomber disk cerrahisinin sık bir komplikasyonu olan epidural fibrozis üzerine etkisini incelemektir. yÖNTem ve GeReÇLeR: Sağ L4-5 hemilaminatomive anular fenestrasyonu yapılmış 60 Spraque Dawley dişi sıçan 3 gruba ayrıldı. Grup 1 (kontrol grubu) ve Grup 2 (topikal sitikolin grubu)'deki sıçanlara cerrahi alan üzerine sırasıyla 0,9% serum fizyolojik ve 100 µM sitikolin uygulanırken, Grup 3 (sistemik sitikolin grubu)'deki sıçanlara intraperitoneal yolla 600 µmol/kg sitikolin verildi. Sıçanlar 4 hafta sonra öldürüldü ve vertebral kolonları blok olarak çıkarıldı. Gruplar histolojik kriterlere göre değerlendirildi ve sonuçlar istatistiksel yöntemler kullanılarak karşılaştırıldı.BuLGuLAR: Topikal ve sistemik sitikolin ile tedavi edilen (Grup 2 ve 3) gruplarda kontrol grubuna kıyasla istatistiksel olarak daha az epidural fibrozis, dural yapışıklık, fibroblast hücre yoğunluğu, yabancı cisim reaksiyonu ve medulla spinalis retraksiyonu gözlendi (p<0,001). İncelenen parametreler bakımından iki tedavi grubu arasında anlamlı bir fark bulunmadı (p>0,05). soNuÇ: Çalışmamız literatürde ilk kez sitikolin'in postoperatif epidural fibrozisi önlemede efektif olabileceğini göstermiştir. Ancak sitikolinin etki mekanizmaları ve klinik etkinliği ilerideki çalışmalarla araştırılmalıdır.

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Recurrent pain after lumbar discectomy: the diagnostic value of peridural scar on MRI

Cited by 44 publications

References 40 publications

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients

Prevention of epidural fibrosis in rats by local or systemic administration of citicoline

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