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[The post-diskotomy syndrome].

J Krämer1

  • 1Orthopädischen Universitätsklinik Bochum im St. Josefs-Hospital.

Zeitschrift Fur Orthopadie Und Ihre Grenzgebiete
|November 1, 1987
PubMed
Summary

Epidural scars after lumbar disc surgery can cause back and leg pain. Prevention through careful surgical indication is key to avoiding post-discectomy syndrome.

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Pain Management

Background:

  • Lumbar disc operations can lead to epidural scar formation in some patients.
  • Epidural scarring may manifest as back and leg pain, often accompanied by a positive bilateral straight leg raise test.
  • Diagnostic imaging like myelography and CT scans can visualize these epidural scars.

Purpose of the Study:

  • To describe the clinical presentation and diagnostic findings associated with epidural scarring post-lumbar disc surgery.
  • To outline conservative and surgical treatment options for symptomatic epidural scars.
  • To emphasize the importance of prophylactic measures in preventing post-discectomy syndrome.

Main Methods:

  • Review of clinical cases presenting with symptoms suggestive of epidural scarring after lumbar disc surgery.
  • Utilizing diagnostic imaging (myelography, CT) for scar identification.
  • Evaluation of treatment outcomes for local steroid injections and lumbosacral distraction spondylodesis.

Main Results:

  • Symptomatic epidural scars present with characteristic back and leg pain and neurological signs.
  • Conservative treatment involves local steroid injections.
  • Surgical intervention, such as lumbosacral distraction spondylodesis with autologous bone graft, may offer relief.
  • Prophylaxis is crucial, highlighting the need for appropriate indications for primary disc operations, specifically avoiding discectomy when not indicated to prevent post-discectomy syndrome.

Conclusions:

  • Epidural scarring is a potential complication of lumbar disc surgery, leading to persistent pain.
  • Early diagnosis and appropriate management, including conservative and surgical options, are important.
  • Strict adherence to surgical indications, particularly regarding discectomy, is the most effective strategy for prophylaxis against post-discectomy syndrome.

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