Epidural adhesions after chymopapain chemonucleolysis.

Area of Science:

• Neurosurgery
• Spinal Surgery
• Pain Management

Background:

• Chymopapain chemonucleolysis is a treatment for herniated discs.
• Failed chemonucleolysis can necessitate further interventions.
• Epidural adhesions are a potential complication in spinal procedures.

Purpose of the Study:

• To investigate the characteristics of epidural adhesions in patients with failed chymopapain chemonucleolysis.
• To determine the potential role of these adhesions in treatment failure and surgical outcomes.

Main Methods:

• Surgical observation in nine patients undergoing surgery for failed chemonucleolysis.
• Histological analysis of epidural adhesions.
• Comparison with post-mortem controls and adhesions in non-injected patients.

Main Results:

• Epidural adhesions were identified in seven of nine patients.
• Adhesions were vascular, prolific, and adhered to neural structures.
• Histology showed increased fibrous tissue without inflammation, similar to controls but with less cellularity.
• Adhesions were also found in a non-injected patient.

Conclusions:

• Epidural adhesions may contribute to the failure of chymopapain chemonucleolysis.
• These adhesions can complicate subsequent surgeries by promoting further adhesion formation.
• Understanding adhesion formation is crucial for improving spinal treatment outcomes.