Sciatica caused by perifibrosis of the sciatic nerve

Merrild, Ulrik; Søgaard, Ib

doi:10.1302/0301-620x.68b5.3782227

Cited by 33 publications

(15 citation statements)

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“…Compression of nerve tissue, furthermore, can induce clinical symptoms such as numbness, pain and muscle weakness (27,36). There is considerable suggestion in the literature (7,14,20,22,25,33,38) that peridural scar formation after disc surgery contributes significantly to unfavorable outcome and recurring symptoms. North et al(1991), for example, reported that favorable outcome for the patients they evaluated was associated with absence of peridural scar requiring surgical lysis.…”

Section: Methodsmentioning

confidence: 99%

“…reports suggesting that fibrosis and adhesions can cause compression or tethering of the nerve root, which may cause recurrent radicular pain and physical impairment. The literature does not establish a definite rate of fibrosis-related problems following lumbar discectomy, but it is repeatedly suggested that fibrosis may be a major cause of recurrent symptoms when no alternative bony or disc pathology can be discerned (2,3,7,9,14,19,20,22,25,28,29,38). While it has been suggested that fibrosis may be causal in as much as 24% of all failed back surgery syndrome cases (6,35), no previous studies have provided proof of a correlation between peridural scar and recurrent radicular pain.…”

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Association Between Peridural Scar and Recurrent Radicular Pain After Lumbar Discectomy: Magnetic Resonance Evaluation

et al. 1996

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The purpose of this study was to investigate the presence of any correlation between recurrent radicular pain during the first six months following first surgery for herniated lumbar intervertebral disc and the amount of lumbar peridural fibrosis as defined by MR imaging. 197 patients who underwent first-time single-level unilateral discectomy for lumbar disc herniation were evaluated in a randomized, double-blind, controlled multicenter clinical trial. Clinical assessments, performed by physicians blinded to patient treatment status, were conducted preoperatively and at one and six months postoperatively. The enhanced MR images of the operative site utilized in the analysis were obtained at six months postoperatively. Radicular pain was recorded by the patient using a validated visual analog pain scale in which 0 = no pain and 10 = excruciating pain. The data obtained at the 6 month time point were analyzed for an association between amount of peridural scars as measured by MR imaging and clinical failure as defined by the recurrence of radicular pain. The results showed that the probability of recurrent pain increases when scar score increases. Patients having extensive peridural scar were 3.2 times more likely to experience recurrent radicular pain than those patients with less extensive peridural scarring. In conclusion, this prospective, controlled, randomized, blinded, multicenter study has demonstrated that there is a significant association between the presence of extensive peridural scar and the occurrence of recurrent radicular pain.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Association Between Peridural Scar and Recurrent Radicular Pain After Lumbar Discectomy: Magnetic Resonance Evaluation

et al. 1996

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“…Inflammation and adhesions [1] on and about the dura and spinal nerves are presumed to be among the major causes of chronic back pain and radiculopathy. Because soft tissue pathology is not easily examined, it is often overlooked as the cause of some back pain syndromes.…”

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confidence: 99%

Spinal endoscopy

Addison

1999

Current Review of Pain

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“…7,12,14,36,38 Key and Ford 26 were the first to describe scar tissue-entrapped nerve root after lumbar laminectomy. They theorized that the anulus fibrosis was the source of the postlaminectomy scar tissue.…”

Section: Discussionmentioning

confidence: 99%

Low-dose radiotherapy for the inhibition of peridural fibrosis after reexploratory nerve root decompression for postlaminectomy syndrome

Gerszten¹,

Moossy²,

Flíckinger³

et al. 2003

Journal of Neurosurgery: Spine

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Object. The authors of clinical studies have demonstrated a significant association between the presence of extensive post—lumbar discectomy peridural scar formation and the recurrence of low-back and radicular pain. Low-dose perioperative radiotherapy has been demonstrated to inhibit peridural fibrosis after laminectomy in animal models. The present study was designed to evaluate the clinical efficacy of preoperative irradiation in patients with failed—back surgery syndrome due to peridural fibrosis who underwent reexploration and nerve root decompression. Methods. Ten patients with symptomatic post—discectomy peridural fibrosis were randomized. Half of the patients underwent 700-cGy external-beam irradiation to the operative site 24 hours prior to reexploration and decompressive treatment of their symptomatic nerve root(s) (treatment group) and the other half underwent reexploration and decompressive treatment without preoperative irradiation (control group). All patients underwent simulated irradiation so neither patient nor surgeon was aware of the patient's group. In all patients the antiadhesion product ADCON-L was placed over the affected nerve root at the time of surgery. Clinical outcome was assessed using the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section Lumbar Disc Herniation Study Questionnaire at baseline, 6 weeks, 3 months, and 1 year follow up. Five men and five women (mean age 42 years) underwent randomization and surgery. Three patients underwent reexploration at L4–5, four at L5—S1, and three at both levels. No complication was associated with irradiation, and no new neurological deficits occurred. At 1-year follow-up examination, three irradiation-treated patients were pain free and two experienced improvement. In the control group, three patients experienced improved pain relief and two were unchanged. There was a trend toward better outcome at 1 year in the radiotherapy-treated group (p = 0.056). Conclusions. Preoperative low-dose external-beam irradiation improved clinical outcomes after reexploration and decompression of nerve roots affected by postlaminectomy peridural fibrosis causing radicular pain. The addition of preoperative irradiation may improve outcome in patients who undergo reoperation for recurrent radicular pain associated with a significant amount of peridural fibrosis, particularly now that no antiadhesion product is available for clinical use.

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Sciatica caused by perifibrosis of the sciatic nerve

Cited by 33 publications

References 0 publications

Association Between Peridural Scar and Recurrent Radicular Pain After Lumbar Discectomy: Magnetic Resonance Evaluation

Association Between Peridural Scar and Recurrent Radicular Pain After Lumbar Discectomy: Magnetic Resonance Evaluation

Spinal endoscopy

Low-dose radiotherapy for the inhibition of peridural fibrosis after reexploratory nerve root decompression for postlaminectomy syndrome

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