Neurological research
-
Neurological research · Jan 1999
Randomized Controlled Trial Multicenter Study Clinical TrialAssociation between peridural scar and activity-related pain after lumbar discectomy.
The purpose of this study was to investigate the correlation between activity-related pain six months after first surgery for herniated lumbar disc, and the extent of lumbar epidural fibrosis present at the surgical site, assessed by magnetic resonance imaging. The 298 patients who underwent surgery for lumbar disc herniation were studied in a randomized, controlled, double-blind multicenter clinical trial to test the effectiveness of the scar-inhibiting device ADCON-L. Clinical assessments were conducted pre-operatively and at 1, 3, and 6 month intervals post-operatively, and included wound examination, magnetic resonance imaging scar assessment, and the Johns Hopkins activity-related pain questionnaire. ⋯ Repeated measures analysis demonstrated that patients who received treatment with ADCON-L at the time of surgery experienced less activity-related pain through the 12-month assessment (p = 0.05). A significant association between extensive epidural scar and activity-related pain is demonstrated. Patients with less scar had less activity related pain, confirming the finding that the use of the scar inhibitor ADCON-L has a positive effect on surgical outcome.
-
Neurological research · Jan 1999
ReviewEpidural fibrosis and the failed back surgery syndrome: history and physical findings.
Patients who present with recurrent symptoms after surgical intervention aimed at correcting their lumbosacral disease pose a therapeutic challenge. A heterogeneous group of factors may underlie symptom recurrence and formulation of a therapeutic strategy depends on an accurate diagnosis of the patient's underlying problem. In this review, the authors discuss the relevant historical and physical findings in patients with epidural fibrosis and the failed back surgery syndrome.