Spinal arthrodesis via lumbar interbody fusion without direct decompression as a treatment for recurrent radicular pain due to epidural fibrosis: patient series.
BMP = bone morphogenic protein
CSF = cerebrospinal fluid
MRI = magnetic resonance imaging
PEEK = polyetheretherketone
anterior lumbar interbody fusion
epidural fibrosis
lateral interbody fusion
lumbar radiculopathy
spine
Journal
Journal of neurosurgery. Case lessons
ISSN: 2694-1902
Titre abrégé: J Neurosurg Case Lessons
Pays: United States
ID NLM: 9918227275606676
Informations de publication
Date de publication:
17 May 2021
17 May 2021
Historique:
received:
10
02
2021
accepted:
18
03
2021
entrez:
20
7
2022
pubmed:
17
5
2021
medline:
17
5
2021
Statut:
epublish
Résumé
Lumbar radiculopathy is the most common indication for lumbar discectomy, but residual postoperative radicular symptoms are common. Postoperative lumbar radiculopathy secondary to scar formation is notoriously difficult to manage, with the mainstay of treatment focused on nonoperative techniques. Surgical intervention for epidural fibrosis has shown unacceptably high complication rates and poor success rates. Three patients underwent spinal arthrodesis without direct decompression for recurrent radiculopathy due to epidural fibrosis. Each patient previously underwent lumbar discectomy but subsequently developed recurrent radiculopathy. Imaging revealed no recurrent disc herniation, although it demonstrated extensive epidural fibrosis and scar in the region of the nerve root at the previous surgical site. Dynamic radiographs showed no instability. Two patients underwent lateral lumbar interbody fusion, and one patient underwent anterior lumbosacral interbody fusion. Each patient experienced resolution of radicular symptoms by the 1-year follow-up. Average EQ visual analog scale scores improved from 65 preoperatively to 78 postoperatively. Spinal arthrodesis via lumbar interbody fusion, without direct decompression, may relieve pain in patients with recurrent radiculopathy due to epidural fibrosis, even in the absence of gross spinal instability.
Sections du résumé
BACKGROUND
BACKGROUND
Lumbar radiculopathy is the most common indication for lumbar discectomy, but residual postoperative radicular symptoms are common. Postoperative lumbar radiculopathy secondary to scar formation is notoriously difficult to manage, with the mainstay of treatment focused on nonoperative techniques. Surgical intervention for epidural fibrosis has shown unacceptably high complication rates and poor success rates.
OBSERVATIONS
METHODS
Three patients underwent spinal arthrodesis without direct decompression for recurrent radiculopathy due to epidural fibrosis. Each patient previously underwent lumbar discectomy but subsequently developed recurrent radiculopathy. Imaging revealed no recurrent disc herniation, although it demonstrated extensive epidural fibrosis and scar in the region of the nerve root at the previous surgical site. Dynamic radiographs showed no instability. Two patients underwent lateral lumbar interbody fusion, and one patient underwent anterior lumbosacral interbody fusion. Each patient experienced resolution of radicular symptoms by the 1-year follow-up. Average EQ visual analog scale scores improved from 65 preoperatively to 78 postoperatively.
LESSONS
CONCLUSIONS
Spinal arthrodesis via lumbar interbody fusion, without direct decompression, may relieve pain in patients with recurrent radiculopathy due to epidural fibrosis, even in the absence of gross spinal instability.
Identifiants
pubmed: 35855018
doi: 10.3171/CASE2173
pii: CASE2173
pmc: PMC9245850
doi:
Types de publication
Case Reports
Langues
eng
Pagination
CASE2173Informations de copyright
© 2021 The authors.
Déclaration de conflit d'intérêts
Disclosures Dr. Park reported personal fees from Globus Medical, NuVasive, and Allosource as well as grants from Pfizer, Vertex, Depuy, Cerapedics, and SI Bone outside the submitted work. Dr. Park is also involved in non–study-related research funded by the International Spine Study Group and Depuy. Dr. Oppenlander reported personal fees from Globus Medical, Bioventus Surgical, Depuy Spine, and LifeNet Health outside the submitted work.
Références
BMC Musculoskelet Disord. 2017 Jul 20;18(1):312
pubmed: 28728580
Spine (Phila Pa 1976). 2003 Aug 1;28(15):1659-65
pubmed: 12897488
Acta Neurochir Suppl. 1995;64:116-8
pubmed: 8748597
BMC Anesthesiol. 2005 Jul 06;5:10
pubmed: 16000173
Pain Physician. 2013 Apr;16(2 Suppl):SE125-50
pubmed: 23615889
World Neurosurg. 2020 Jan;133:e26-e30
pubmed: 31398523
Neurol Res. 1999;21 Suppl 1:S43-6
pubmed: 10214571
Spine (Phila Pa 1976). 2002 Nov 15;27(22):2547-53; discussion 2554
pubmed: 12435991
J Craniovertebr Junction Spine. 2017 Oct-Dec;8(4):305-310
pubmed: 29403240
J Bone Joint Surg Br. 1986 Nov;68(5):706
pubmed: 3782227
J Neurosurg Spine. 2010 Feb;12(2):178-82
pubmed: 20121353
Spine (Phila Pa 1976). 1978 Sep;3(3):256-9
pubmed: 152469
Eur Spine J. 2004 May;13(3):193-8
pubmed: 14752624
Acta Neurochir (Wien). 1998;140(1):9-13
pubmed: 9522901
Neurosurg Focus. 2016 Feb;40(2):E3
pubmed: 26828884
Eur Spine J. 2005 May;14(4):409-14
pubmed: 15526220
Arch Phys Med Rehabil. 2001 May;82(5):691-3
pubmed: 11346850
J Craniovertebr Junction Spine. 2014 Oct;5(4):141-2
pubmed: 25558142
Spine (Phila Pa 1976). 2017 May 15;42(10):755-763
pubmed: 27584678