Re-Operations Performed on Patients Suffering from an Intervertebral Disc Prolapse in the Lumbar Region

Schlarb, Haley; Wenker, H

doi:10.1007/978-3-642-66578-3_8

Cited by 12 publications

(2 citation statements)

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“…54 Reoperation for scar removal often leads to a poor outcome and further scarring. 6,15,32,40,46,51 Most experts currently do not recommend reoperation when fibrosis is suspected to be the only cause of FBSS. 42 Less than one third of the patients in whom reoperation is performed after lumbar disc surgery for peridural fibrosis experience persistent improvement of their symptoms.…”

Section: Discussionmentioning

confidence: 99%

Low-dose radiotherapy for the inhibition of peridural fibrosis after reexploratory nerve root decompression for postlaminectomy syndrome

Gerszten¹,

Moossy²,

Flíckinger³

et al. 2003

Journal of Neurosurgery: Spine

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Object. The authors of clinical studies have demonstrated a significant association between the presence of extensive post—lumbar discectomy peridural scar formation and the recurrence of low-back and radicular pain. Low-dose perioperative radiotherapy has been demonstrated to inhibit peridural fibrosis after laminectomy in animal models. The present study was designed to evaluate the clinical efficacy of preoperative irradiation in patients with failed—back surgery syndrome due to peridural fibrosis who underwent reexploration and nerve root decompression. Methods. Ten patients with symptomatic post—discectomy peridural fibrosis were randomized. Half of the patients underwent 700-cGy external-beam irradiation to the operative site 24 hours prior to reexploration and decompressive treatment of their symptomatic nerve root(s) (treatment group) and the other half underwent reexploration and decompressive treatment without preoperative irradiation (control group). All patients underwent simulated irradiation so neither patient nor surgeon was aware of the patient's group. In all patients the antiadhesion product ADCON-L was placed over the affected nerve root at the time of surgery. Clinical outcome was assessed using the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section Lumbar Disc Herniation Study Questionnaire at baseline, 6 weeks, 3 months, and 1 year follow up. Five men and five women (mean age 42 years) underwent randomization and surgery. Three patients underwent reexploration at L4–5, four at L5—S1, and three at both levels. No complication was associated with irradiation, and no new neurological deficits occurred. At 1-year follow-up examination, three irradiation-treated patients were pain free and two experienced improvement. In the control group, three patients experienced improved pain relief and two were unchanged. There was a trend toward better outcome at 1 year in the radiotherapy-treated group (p = 0.056). Conclusions. Preoperative low-dose external-beam irradiation improved clinical outcomes after reexploration and decompression of nerve roots affected by postlaminectomy peridural fibrosis causing radicular pain. The addition of preoperative irradiation may improve outcome in patients who undergo reoperation for recurrent radicular pain associated with a significant amount of peridural fibrosis, particularly now that no antiadhesion product is available for clinical use.

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Section: Discussionmentioning

confidence: 99%

Low-dose radiotherapy for the inhibition of peridural fibrosis after reexploratory nerve root decompression for postlaminectomy syndrome

Gerszten¹,

Moossy²,

Flíckinger³

et al. 2003

Journal of Neurosurgery: Spine

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“…Η εμμονή και η επιδείνωση της συμπτωματολογίας καθώς και ο απεικονιστικός έλεγχος οδήγησαν στην πρώιμη αναγνώρισή του και στην κατάλληλη χειρουργική του αντιμετώπιση. Αντιθέτως στην σειρά του Greenwood και συν (42) που και εκεί αποτελούσε την μοναδική περίπτωση, τα αποτελέσματα δεν ήταν ικανο ποιητικά ( "not good" ) ΜΗ ΙΚΑΝΟΠΟΙΗΤΙΚΑ ΑΠΟΤΕΛΕΣΜΑΤΑ α) Επισκληρίδια ίνωση Η πλειονότητα των συγγραφέων συμφωνεί ότι στις περιπτώσεις με επισκληρίδια ίνωση, αμιγή ή μη, τα μετεγχειρητικά αποτελέσματα γενικώς δεν είναι ικανοποιητικά ( 30,33,42,57,72,18,34,81,97,53,67). Στην έρευνα μας, στο σύνολο 59 επαναχειρουργηθέντων περιπτώσεων, 21 περιπτώσεις βρέθηκαν με χειρουργικώς διαπιστωθείσα εκτετα μένη επισκληρίδια ίνωση.Από αυτές,οι 7 ήσαν αμιγείς ενώ οι 14 συνόδευαν στενώ σεις του συστοίχου πλαγίου εγκολπώματος.…”

Section: συζητησηunclassified