Prevention of epidural fibrosis in a prospective series of 100 primary lumbo-sacral discectomy patients: follow-up and assessment at re-operation.
An implantable device (ADCON-L), which acts as a resorbable barrier to epidural fibrosis following lumbar discectomy, has been shown to minimize the formation of peridural fibrotic scar and to improve the post-operative outcome, in two large controlled and multi-center clinical trials. In this prospective study, 100 patients were treated with the device during their first-time lumbo-sacral discectomy surgeries and monitored for 12 months. During this time interval, four of these patients required re-operation. In these cases, epidural scar and ease of dissection were systematically evaluated and recorded. At the time of re-operation, in all four patients, absent or minimal soft scar tissue was found where ADCON-L had been placed, no adhesions to the involved root were observed, and the dissection was easier than expected; the healing of the surgical wound was excellent , and no residual implant material was found. These observations indicate that the use of ADCON-L at the time of the first lumbar disc surgery minimizes the hazards and difficulty that can be encountered in a subsequent revision surgery due to the presence of epidural fibrosis, and may therefore improve the chances of satisfactory outcome following re-operation.
Brotchi
J
J
Service de Neurochirurgie, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Pirotte
B
B
De Witte
O
O
Levivier
M
M
D000293:Adolescent; D000328:Adult; D002921:Cicatrix / Q000517:prevention & control; D017586:Diskectomy; D004824:Epidural Space; D005069:Evaluation Studies as Topic; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome