Computed Tomography of Epidural Fibrosis after Discectomy: A Comparison between Symptomatic and Asymptomatic Patients

Abstract

The evaluation of patients with symptoms recurrent after disc surgery is a difficult diagnostic problem. The most common causes are recurrent herniation and postoperative scarring; routine x-ray and myelographic differentiation between herniation and scarring is difficult or impossible. High resolution computed tomography (CT) has shown some results in the evaluation of postoperative patients, but the role of epidural fibrosis in failed back surgery syndrome (FBSS) is not clear. Some knowledge of the "normal" CT physiological healing and scarring after disc surgery is necessary. We scanned 20 asymptomatic operated patients and 20 patients with recurrent sciatic nerve pain after disc surgery who did not have bony stenosis, recurrent disc herniation, or other causes of FBSS. Our observations showed no important differences in the fibrosis demonstrated by CT between symptomatic and asymptomatic patients. The degree and type of fibrosis are not related to recurrent symptoms.

Learning curve of full-endoscopic lumbar discectomy

“…Minimal instrumentation and injury to the ligamentum flavum is a potential benefit of endoscopic discectomy. About 5-12 % of failed back syndrome is caused by epidural fibrosis in patients who underwent lumbar disk surgery [24]. Reduced trauma to the ligamentum flavum appears to limit epidural fibrosis [25].…”

Epidural Lysis of Adhesions and Percutaneous Neuroplasty

“…The contribution of fibrosis to the etiology of low back pain has been debated [7][8][9]. There are many possible etiologies of epidural fibrosis, including surgical trauma, an annular tear, infection, hematoma, or intrathecal contrast material [10].…”

Epidural Lysis of Adhesions and Percutaneous Neuroplasty

“…6 The contribution of fibrosis to the etiology of low back pain has been debated. [7][8][9] There are many possible etiologies of epidural fibrosis, including surgical trauma, an annular tear, infection, hematoma, or intrathecal contrast material. 10 These etiologies have been well documented in the literature.…”

“…It is widely accepted that postoperative scar renders the nerve susceptible to injury by a compressive phenomena. 9 It is natural for connective tissue or any kind of scar tissue to form fibrous layers (scar tissue) as a part of the process that transpires after disruption of the intact milieu. 15 Scar tissue is generally found in three components of the epidural space.…”