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Epidural Fibrosis after Lumbar Disc Surgery: Prevention and Outcome Evaluation.

Mohi Eldin MM, Abdel Razek NM - Asian Spine J (2015)

Bottom Line: EF contributes to significant unsatisfactory failed-back syndrome.Efforts have been tried to reduce postoperative EF, but none were ideal.A simple grading system of EF on MRI was described.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.

ABSTRACT

Study design: This is a prospective, randomized, controlled study designed and conducted over 10 years from 2002 to 2012.

Purpose: The 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 literature: EF contributes to significant unsatisfactory failed-back syndrome. Efforts have been tried to reduce postoperative EF, but none were ideal.

Methods: Between 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).

Results: The 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).

Conclusions: This 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.

No MeSH data available.


Related in: MedlinePlus

Control patient 35 year's old, male, with history of L4-5 left posterolateral disc herniation treated surgically by spinolaminectomy at L4-5 level. Magnetic resonance imaging (MRI) study done after 1 year (A) are axial consequent MRI images T1-weighted before contrast showing a ventral and left ventrolateral low signal intensity, involving the left upper outer quadrant and encroaching upon the left L4-5 neural exit foramen. After gadolinium with DTPA (diethylenetriaminepentacetate) (B), there is an enhancing epidural scarring involving the mentioned quadrant (grade: mild to moderate EF). EF, epidural fibrosis.
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Figure 8: Control patient 35 year's old, male, with history of L4-5 left posterolateral disc herniation treated surgically by spinolaminectomy at L4-5 level. Magnetic resonance imaging (MRI) study done after 1 year (A) are axial consequent MRI images T1-weighted before contrast showing a ventral and left ventrolateral low signal intensity, involving the left upper outer quadrant and encroaching upon the left L4-5 neural exit foramen. After gadolinium with DTPA (diethylenetriaminepentacetate) (B), there is an enhancing epidural scarring involving the mentioned quadrant (grade: mild to moderate EF). EF, epidural fibrosis.

Mentions: Fig. 8 demonstrates a control male patient 35 year's old, with history of L4-5 left posterolateral disc herniation treated surgically by spinolaminectomy at L4-5 level. The MRI study done after 1 year (Fig. 8A) were axial consequent MRI images T1-eighted before contrast showing a ventral and left ventrolateral low signal intensity, involving the left upper outer quadrant and encroaching upon the left L4-5 neural exit foramen. After gadolinium-diethylenetriaminepentacetate (Gd-DTPA) (Fig. 8B), there was an enhancing epidural scarring involving the mentioned quadrant (grade: mild to moderate scar).


Epidural Fibrosis after Lumbar Disc Surgery: Prevention and Outcome Evaluation.

Mohi Eldin MM, Abdel Razek NM - Asian Spine J (2015)

Control patient 35 year's old, male, with history of L4-5 left posterolateral disc herniation treated surgically by spinolaminectomy at L4-5 level. Magnetic resonance imaging (MRI) study done after 1 year (A) are axial consequent MRI images T1-weighted before contrast showing a ventral and left ventrolateral low signal intensity, involving the left upper outer quadrant and encroaching upon the left L4-5 neural exit foramen. After gadolinium with DTPA (diethylenetriaminepentacetate) (B), there is an enhancing epidural scarring involving the mentioned quadrant (grade: mild to moderate EF). EF, epidural fibrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4472585&req=5

Figure 8: Control patient 35 year's old, male, with history of L4-5 left posterolateral disc herniation treated surgically by spinolaminectomy at L4-5 level. Magnetic resonance imaging (MRI) study done after 1 year (A) are axial consequent MRI images T1-weighted before contrast showing a ventral and left ventrolateral low signal intensity, involving the left upper outer quadrant and encroaching upon the left L4-5 neural exit foramen. After gadolinium with DTPA (diethylenetriaminepentacetate) (B), there is an enhancing epidural scarring involving the mentioned quadrant (grade: mild to moderate EF). EF, epidural fibrosis.
Mentions: Fig. 8 demonstrates a control male patient 35 year's old, with history of L4-5 left posterolateral disc herniation treated surgically by spinolaminectomy at L4-5 level. The MRI study done after 1 year (Fig. 8A) were axial consequent MRI images T1-eighted before contrast showing a ventral and left ventrolateral low signal intensity, involving the left upper outer quadrant and encroaching upon the left L4-5 neural exit foramen. After gadolinium-diethylenetriaminepentacetate (Gd-DTPA) (Fig. 8B), there was an enhancing epidural scarring involving the mentioned quadrant (grade: mild to moderate scar).

Bottom Line: EF contributes to significant unsatisfactory failed-back syndrome.Efforts have been tried to reduce postoperative EF, but none were ideal.A simple grading system of EF on MRI was described.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.

ABSTRACT

Study design: This is a prospective, randomized, controlled study designed and conducted over 10 years from 2002 to 2012.

Purpose: The 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 literature: EF contributes to significant unsatisfactory failed-back syndrome. Efforts have been tried to reduce postoperative EF, but none were ideal.

Methods: Between 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).

Results: The 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).

Conclusions: This 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.

No MeSH data available.


Related in: MedlinePlus