[Spinal epidural fibrosis following lumbar diskectomy and antiadhesion barrier].
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.
Isla
A
A
Servicio de Neurocirugía, Hospital La Paz, Madrid.
Alvarez
F
F
D017586:Diskectomy / Q000009:adverse effects*; D004311:Double-Blind Method; D004824:Epidural Space; D005355:Fibrosis / Q000517:prevention & control; D005782:Gels / Q000627:therapeutic use*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae; D009930:Organic Chemicals; D011446:Prospective Studies; D013122:Spinal Diseases / Q000517:prevention & control*; D013131:Spine / Q000473:pathology*; D000267:Tissue Adhesions
C104199:ADCON-L; D005782:Gels; D009930:Organic Chemicals
Fibrosis epidural espinal postdiscectomía lumbar y barrera antiadhesiva.