title: Epidural Fibrosis after Lumbar Disc Surgery: Prevention and Outcome Evaluation.
abstract: METHODS
  This is a prospective, randomized, controlled study designed and conducted over 10 years from 2002 to 2012.
  
  
  OBJECTIVE
  The study aimed to monitor the effect of suction drains (SD) on the incidence of epidural fibrosis (EF) and to test, if the use of SD alone, SD with local steroids application, SD combined with fat grafts and local steroids application, or SD combined with fat grafts and without local steroids application, would improve outcome.
  
  
  BACKGROUND
  EF contributes to significant unsatisfactory failed-back syndrome. Efforts have been tried to reduce postoperative EF, but none were ideal.
  
  
  METHODS
  Between September 2002 and 2012, 290 patients with symptomatic unilateral or bilateral, single-level lumbar disc herniation were included in the study. Two groups were included, with 165 patients in group I (intervention group) and 125 patients in group II (control group). Group I was subdivided into four subgroups: group Ia (SD alone), group Ib (SD+fat graft), group Ic (SD+local steroids), and group Id (SD+fat graft+local steroids).
  
  
  RESULTS
  The use of SD alone or combined with only fat grafts, fats grafts and local steroids application, or only local steroids application significantly improved patient outcome and significantly reduced EF as measured by magnetic resonance imaging (MRI).
  
  
  CONCLUSIONS
  This study has clearly demonstrated the fact that the use of suction drainage alone or combined with only fat grafts, fats grafts and local steroids application, or only local steroids application significantly improved patient outcome with respect to pain relief and functional outcome and significantly reduced EF as measured by an MRI. A simple grading system of EF on MRI was described.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Mohi Eldin
authors.affiliation: Department of Radiodiagnosis, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Naglaa M
authors.initials: NM
authors.lastname: Abdel Razek
keywords: Epidural fibrosis; Failed back; Lumbar; Prevention; Suction drain