Association Between Peridural Scar and Recurrent Radicular Pain After Lumbar Discectomy: Magnetic Resonance Evaluation

Abstract

The purpose of this study was to investigate the presence of any correlation between recurrent radicular pain during the first six months following first surgery for herniated lumbar intervertebral disc and the amount of lumbar peridural fibrosis as defined by MR imaging. 197 patients who underwent first-time single-level unilateral discectomy for lumbar disc herniation were evaluated in a randomized, double-blind, controlled multicenter clinical trial. Clinical assessments, performed by physicians blinded to patient treatment status, were conducted preoperatively and at one and six months postoperatively. The enhanced MR images of the operative site utilized in the analysis were obtained at six months postoperatively. Radicular pain was recorded by the patient using a validated visual analog pain scale in which 0 = no pain and 10 = excruciating pain. The data obtained at the 6 month time point were analyzed for an association between amount of peridural scars as measured by MR imaging and clinical failure as defined by the recurrence of radicular pain. The results showed that the probability of recurrent pain increases when scar score increases. Patients having extensive peridural scar were 3.2 times more likely to experience recurrent radicular pain than those patients with less extensive peridural scarring. In conclusion, this prospective, controlled, randomized, blinded, multicenter study has demonstrated that there is a significant association between the presence of extensive peridural scar and the occurrence of recurrent radicular pain.

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

“…The formation of postoperative epidural fibrosis is an inevitable result of laminectomy. Although the relationship between epidural fibrosis and clinical symptoms of FBSS has not been unequivocally proven, as many as 24% of all FBSS cases may be attributed to epidural scar adhesion [27].The mechanical tethering of nerve roots, or the dura, by the excessive formation of epidural fibrosis may be a contributing factor for a significant subset of patients suffering from FBSS [3,26,27]. However, several authors have reported that there are no important differences between symptomatic and asymptomatic patients in fibrosis demonstrated by computed tomography (CT) and magnetic resonance imaging (MRI).…”

“…The reasons for FBSS include inadequate surgical decompression, recurrent disc herniation, lumbar instability, extensive epidural scar, and inadequate fusion [7]. The postoperative epidural scar can cause extradural compression or dural tethering, which results in recurrent radicular pain and physical impairment [27].…”

Significance of the mass-compression effect of postlaminectomy/laminotomy fibrosis on histological changes on the dura mater and nerve root of the cauda equina: an experimental study in rats

“…In accord with this, we found significantly less fibrosis in the laminotomy group than in the laminectomy group, and the grade of epidural fibrosis also increased over time, especially in the laminectomy group. However, the definite pathomechanism that lies between epidural fibrosis and neural dysfunction is still uncertain [14,21,22]. Many clinical reports rely on MRI studies to assess scar formation and spinal canal compromise.…”

Effect of straight-leg-raising movement on epidural fibrosis in early stage after laminectomy in a rabbit model

“…Approximately 5 % to 24 % of all cases of FBSS were the results of epidural fibrosis [1,2,5] . Ross et al believe that for every 25 % increase in scarring, the risk of recurrent radicular pain increases 2.02 times [6] .…”