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[Spinal epidural fibrosis following lumbar diskectomy and antiadhesion barrier]
Abstract:
Although diskectomy after hemilaminectomy always produces some fibrosis, only few patients develop clinical symptoms. Fibrosis is one of the causes for failed lumbar disc surgery. Identification of fibrosis as the cause of recurring lumbar or sciatic pain requires the existence of a good clinical history and selective physical examination of the patient. MR is the imaging technique of choice although CT and myelography can be useful in some cases. Surgery can correct recurrent hernias, segmentary instability or spinal stenosis, but good results are less likely in patients with epidural fibrosis. When this exists, surgery should be directed to performing an arthrodesis of the vertebral space since the operation itself can destabilize the segment resulting in instability of the affected segment. Application of ADCON-L did not worse and in some cases improved the clinical condition of patients in double blind studies. Our multicentric double blind study showed no clinical differences among 253 patients at six months after surgery. Additionally, since this gel seems to avoid the development of fibrosis, it may prevent one of the main causes of failed disc surgery and, if reoperation is necessary due to disc remains or a lateral stenosis, the absence of fibrosis would facilitate surgery.
Insights
Epidural fibrosis can cause failed back surgery. A multicenter study found ADCON-L gel did not worsen patient outcomes and may prevent fibrosis, potentially improving reoperation success.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Pain Management
Background:
- Post-diskectomy fibrosis is common after hemilaminectomy, sometimes leading to failed lumbar disc surgery.
- Identifying epidural fibrosis as a cause of recurrent pain requires thorough clinical evaluation and imaging.
- Magnetic resonance (MR) imaging is preferred for diagnosing epidural fibrosis, with CT and myelography as alternatives.
Purpose of the Study:
- To evaluate the efficacy and safety of ADCON-L gel in preventing or reducing epidural fibrosis after lumbar disk surgery.
- To assess the impact of ADCON-L on clinical outcomes and the potential for facilitating reoperation if necessary.
Main Methods:
- A multicenter, double-blind study involving 253 patients undergoing lumbar disk surgery.
- Patients were treated with either ADCON-L gel or a control, with outcomes assessed at six months.
- Clinical condition and the presence of fibrosis were evaluated.
Main Results:
- No significant clinical differences were observed between the ADCON-L group and the control group at six months post-surgery.
- ADCON-L application did not worsen patient conditions and showed potential for improvement in some cases.
- The gel appears to reduce the development of epidural fibrosis, potentially simplifying future surgical interventions.
Conclusions:
- ADCON-L gel is safe for use after lumbar disk surgery and does not negatively impact short-term clinical outcomes.
- The gel may serve as an effective measure to prevent epidural fibrosis, a major cause of failed back surgery syndrome.
- Preventing fibrosis with ADCON-L could facilitate reoperations for residual disc herniation or spinal stenosis.
