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

Ross, Jeffrey S.; Robertson, James T.; Frederickson, Robert C.A.; Petrie, Jonathan L.; Obuchowski, Nancy A.; Modic, Michael T.; deTribolet, Nicolas

doi:10.1227/00006123-199604000-00053

Cited by 300 publications

(175 citation statements)

References 33 publications

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“…These factors include misdiagnosis, technical failure, new disc protrusion, bony compression, excessive fibrosis, facet syndrome, infection and instability 7,[22][23][24] . In a retrospective study Osterman et al 25 found a risk of 25,1% of further spinal surgery in the first ten years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Almeida

Poletto

Milano

et al. 2007

Arq. Neuro-Psiquiatr.

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-Lumbar disc herniation (LDH) is a common cause of back and sciatic pain. When clinical treatment fails, surgery may be indicated in selected patients. Although surgery is effective in most cases, some of these patients may have a poor outcome. Different factors may influence these results and poor adaptation at work is one well-known cause of treatment failure. This study examines 350 patients on longterm follow-up after surgery for first-time LDH. The relationship was analyzed between occupation before surgery and outcome (maintenance of lumbar and leg pain, satisfaction with the surgical treatment and return to work). The preoperative occupation (employed in public or private services, autonomous, unemployed, housewife, retired or student) and the exertion at work were analyzed as prognostic factors for different clinical outcomes. Although unemployed people had higher numerical analog scale for lumbar pain and retired patients had a higher leg pain, this difference was not statistically significant. Retired people were significantly less satisfied with the surgical result. Higher exertion at work showed a statistically insignificant higher level of pain and lower degree of satisfaction. The authors conclude that preoperative occupation was not a statistically significant factor in this series of patients.KEY WORDS: lumbar disc herniation, occupation, failed back syndrome, outcome, discectomy.Cirurgia de hérnia de disco lombar: existe relação entre a profissão e a persistência de dor?RESUMO -A hérnia de disco lombar (HDL) é uma causa comum de dor lombar e ciática. Quando o tratamento clínico não oferece melhora dos sintomas, a cirurgia pode ser proposta em casos selecionados. Apesar de ser efetiva, uma pequena, porém significativa parcela dos pacientes operados podem não melhorar. Diversos fatores podem influenciar tais resultados. A insatisfação no ambiente de trabalho é relacionada com um maior índice de maus resultados. Neste estudo, 350 pacientes no pós-operatório tardio da primeira cirurgia de HDL foram estudados, analisando a possível relação entre tipo de profissão antes da cirurgia e evolução clínica (persistência de dor lombar e em membro inferior, satisfação com a cirurgia e retorno ao trabalho). Os pacientes foram classificados quanto à profissão em empregados públicos, empregados em órgãos privados, autônomos, desempregados, donas de casa, aposentados e estudantes. Também o grau de esforço no ambiente de trabalho foi analisado como fator prognóstico. Os desempregados relataram índices de dor lombar maiores e os aposentados tiveram maiores índices de dor irradiada, apesar de que estatisticamente os valores não foram significativos. Os aposentados ficaram significativamente menos satisfeitos com o tratamento no longo prazo. Um maior esforço no ambiente de trabalho não se correlacionou estatisticamente com o grau de dor e satisfação. Concluimos que o tipo de profissão não foi fator estatisticamente significativo na evolução destes pacientes. Os aposentados tiveram menor grau de satisfação co...

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Section: Discussionmentioning

confidence: 99%

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Almeida

Poletto

Milano

et al. 2007

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…In addition, it can cause symptomatic problems, such as radicular pain. Ross et al (1996) show a close relationship between epidural adhesions and recurrent radicular pain or lower back pain after a successful lumbar discectomy. In addition, epidural adhesion leads to difficulties during a revision surgery.…”

Section: Introductionmentioning

confidence: 87%

“…A variety of biological, pharmacological and synthetic materials have been tested in vitro or used in vivo as space-occupying agents. Free or pedicle fat graft (Barberá et al, 1978), Silastic (Alkalay et al, 2003), methylene blue (Farrokhi et al, 2011), ADCON-L (Einhaus et al, 1997), Vicryl mesh (Nussbaum et al, 1990), methacrylate (Lawson et al, 1991), carboxymethyl cellulose (Rodgers et al, 2003), polyethylene oxide (Rodgers et al, 2003), haemostatic agents (Doğulu et al, 2009;Songer et al, 1995), mitomycin C (Lee et al, 2004;Lee et al, 2006), pimecrolimus , absorbable cement (Mehdi et al, 2014), topical high-molecularweight hyaluronan (Kato et al, 2005;Massie et al, 2005;Songer et al, 1990;Chen et al, 2014;Semra et al, 2015) and anti-inflammatory medications (Ross et al, 1996;Cekinmez et al, 2010) have been used with inconsistent results. Therefore, development of a new anti-adhesive material to prevent epidural fibrosis shall benefit spine laminectomy surgery.…”

Section: Mh Hu Et Almentioning

confidence: 99%

In situ forming oxidised hyaluronic acid/adipic acid dihydrazide hydrogel for prevention of epidural fibrosis after laminectomy

Yang²,

Sun

et al. 2017

eCM

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Post-operative epidural fibrosis is a biological response after laminectomy that may lead to clinical symptoms, such as radicular pain. An ideal material for prevention of epidural fibrosis should be able to inhibit fibroblast adhesions and reduce formation of scar tissue. An injectable hydrogel would be the material of choice for this purpose, since it could fill an irregular surgical defect completely, gelate in situ and be delivered in a minimally-invasive manner. The objective of this study was to evaluate, in vitro and in vivo, the cytocompatibility and anti-adhesive effect of an oxidised hyaluronic acid/adipic acid dihydrazide (oxi-HA/ADH) hydrogel. Different cell types present in the spine were used to test the cytocompatibility of the hydrogel. The hydrogel extraction medium had no deleterious effects on neural cells (PC-12), but reduced fibroblasts viability (NIH/3T3). Although the hydrogel did not change the release of lactate dehydrogenase from myoblasts (C2C12) and Schwann cells (RSC96), the extraction medium concentration slightly affected the mitochondrial activity of these two cell types. qPCR showed that the hydrogel down-regulated S100a and P4hb expression in NIH/3T3 cells, supporting the hypothesis that the hydrogel might inhibit fibroblast activity. The animal study showed a reduction of scar tissue formation as well as severity of adhesion between scar tissue and the dura mater in a rat laminectomy model. Superficially, the peel-off test showed significantly decreased tenacity. In conclusion, the oxi-HA/ADH hydrogel is a promising injectable and thermosensitive material for prevention of post-operative epidural fibrosis.

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“…In this condition scar tissue adheres to the dura mater or nerve roots are formed in order to repair the local defect of the vertebral lamina created by the laminectomy. However, this scar formation may be compressive and restrict the mobility of the nerve root which often leads to an unfavourable clinical outcome (North et al 1991;Songer et al 1995;Ross et al 1996). Concurrently epidural fibrosis increases the hazards of revision spine surgery and contributes to the occurrence of the "failed back surgery syndrome" (Robertson 1996;Ross et al 1996;Chan and Peng 2011).…”

Section: Discussionmentioning

confidence: 99%

Reduction of epidural fibrosis after laminectomy in rabbits by omental free graft

Bottegaro¹,

Kos²,

Pirkić³

et al. 2013

Vet. Med. - Czech

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ABSTRACT:Epidural fibrosis is an extradural scar tissue formed after a laminectomy procedure. It is associated with persistent pain after spinal surgery and an increased risk of complications during revision surgery. The aim of this study was to determine the preventive effects of local application of an omental free graft in minimising spinal epidural fibrosis in a rabbit laminectomy model. Twenty two rabbits were randomly divided in two groups, a control group of seven and an experimental group of 15 animals. A dorsal laminectomy at levels L 1 to L 3 was performed on each rabbit of both groups. Prior to the laminectomy procedure, the animals from the experimental group were submitted to a laparotomy in order to obtain the free omental graft. The graft was then applied to the same animal at the dural deffect. All rabbits were euthanised six weeks after surgery and spine segments L 1 to L 3 were removed. Histological sections were evaluated for fibrosis intensity at the laminectomy level, the adhesion degree between dura mater and fibrous tissue and the presence of the foreign body reaction. A statistically significant correlation was established for the foreign body reaction presence and belonging to the group, which can be explained by the omental effects on inflammation reduction and healing promotion. The degree of adhesion between the dura mater and fibrous tissue and the intensity of the fibrous tissue at the laminectomy level were lower in the experimental group although the differences were not statistically significant. The use of free omental grafts is thus a promising technique in epidural fibrosis prevention.

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

Cited by 300 publications

References 33 publications

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

In situ forming oxidised hyaluronic acid/adipic acid dihydrazide hydrogel for prevention of epidural fibrosis after laminectomy

Reduction of epidural fibrosis after laminectomy in rabbits by omental free graft

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