Abstract
Study design: This was a prospective, randomized, multicenter, double-blind study. Objectives: The study evaluated the use of ADCON®-L Anti-Adhesion Barrier Gel to inhibit peridural fibrosis and reduce fibrosis-related symptoms after first-time lumbar discectomy. Summary of background data: Peridural scarring causes tethering of dura and nerve roots, contributing to pain and functional limitation, and that symptoms are evident by 6 months after surgery. Methods: Following discectomy, ADCON-L was applied to patients in the active treatment group. Outcome measures were reduction of peridural scar and postoperative pain. Results: There is an association between peridural scar and recurrent radicular pain. Patients having extensive peridural scar were three times more likely to experience recurrent radicular pain than those patients with less extensive scarring. ADCON-L inhibited peridural scar. Compared to the control group, there was a 23% reduction in the number of patients with extensive peridural scar and a 120% increase in the number of patients having minimal or no scar. ADCON-L reduced the incidence of activity-related pain. There was up to a 50% reduction in the number of patients reporting increased pain while doing typical activities of daily living. Conclusions: ADCON-L is safe, reduces peridural fibrosis, and improves postoperative patient outcome.
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Benoist M, Ficat C, Baraf P, Cauchoix J (1980) Postoperative lumbar epiduroarachnoiditis: diagnostic and therapeutic aspects. Spine 5: 432–436
Boden SC, Wiesel SW (1992) The multiply operated low back patient. In: Rothman RH, Simeone FA (eds) The Spine, 3rd edn. Saunders, Philadelphia, pp 1899–1906
Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB (1981) Causes of failure of surgery on the lumbar spine. Clin Orthop Rel Res 157: 191–199
Cauchoix J, Ficat C, Girard B (1978) Repeat surgery after disc excision. Spine 3: 256–259
Ebeling U, Reichenberg W, Reulen H-J (1986) Results of microsurgical lumbar discectomy: review of 485 patients. Acta Neurochir (Wien) 81: 45–52
Fager CA, Freidberg SR (1980) Analysis of failures and poor results of lumbar spine surgery. Spine 5: 87–94
Finnegan WJ, Fenlin JM, Marvel JP, Nardini RJ, Rothman RH (1979) Results of surgical intervention in the symptomatic multiply-operated back patient. J Bone Joint Surg [Am] 61: 1077–1082
Hoffman RM, Wheeler KJ, Deyo RA (1993) Surgery for herniated lumbar discs: a literature synthesis. J Gen Intern Med 8: 487–496
Hurme M, Katevuo K, Nykvist F, Aalto T, Alaranta H, Einola S (1991) CT five years after myelographic diagnosis of lumbar disk herniation. Acta Radiol 32: 286–389
Jacobs RR, McClain O, Neff J (1980) Control of postlaminectomy scar formation. Spine 5: 223–229
Long DM, McAfee PC (1992) Reoperation on lumbar spine. In: Long DM, McAfee PC (eds) Atlas of Spinal Surgery. Williams & Wilkins, Baltimore, pp 23–57
Long DM, BenDebba M, Torgenson WS (1996) Persistent back pain and sciatica in the United States: patient characteristics (National Low Back Pain Study). J Spinal Dis 9: 40–58
Martin-Ferrer S (1989) Failure of autologous fat grafts to prevent postoperative epidural fibrosis in surgery of the lumbar spine. Neurosurgery 24: 718–721
Merrild U, Sogaard IB (1986) Sciatica caused by perifibrosis of the sciatic nerve. J Bone Joint Surgery 68: 706
North RB, Campbell JN, James CS, et al (1991) Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation. Neurosurgery 28: 685–690
Pappas CTE, Harrington T, Sonntag VKH (1992) Outcome analysis in 654 surgically treated lumbar disc herniations. Neurosurgery 30: 862–866
Pheasant HC (1975) Sources of failure in laminectomies; symposium on the lumbar spine. Orthop Clin North Am 6: 319–329
Robertson JT (1996) The role of peridural fibrosis in the failed back. Eur Spine J 5 (Suppl 1): S2-S6
Robertson JT, Meric AL, Dohan FC, Schweitzer JB, Wujek JR, Ahmad S (1993) The reduction of postlaminectomy peridural fibrosis in rabbits by a carbohydrate polymer. J Neurosurg 79: 89–95
Ross JS, Delamarter R, Hueftle MG et al (1989) Gadolinium-DTPA-enhanced MR imaging of the postoperative lumbar spine MRI. Am J Neuroradiol 10: 37–46
Ross JS, Robertson JT, Frederickson RCA, Petrie JL, et al (1996) Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. Neurosurgery 38: 855–861
Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2: 175–184
Spangfort EV (1972) The lumbar disc herniation: a computer-aided analysis of 2,504 operations. Acta Orthop Scand [Suppl] 142: 5–95
Waddell G, Kummel EG, Lotto WN, Graham JD, Hall H, McCullough JA (1979) Failed lumbar disc surgery and repeat surgery following industrial injuries. J Bone Joint Surg [Am] 61: 201–207
Wiesel SW (1985) The multiply operated lumbar spine. Instr Course Lect 34: 68–77
Weisz GM (1985) The value of CT in diagnosing postoperative lumbar conditions. Spine 11: 164–166
Yong-Hing K, Reilly J, de Korompay V, Kirkaldy-Willis WH (1980) Prevention of nerve root adhesions after laminectomy. Spine 5: 59–64
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This study was supported by a grant from Gliatech Inc.
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Petrie, J.L., Ross, J.S. Use of ADCON®-L to inhibit postoperative peridural fibrosis and related symptoms following lumbar disc surgery: a preliminary report. Eur Spine J 5, S10–S17 (1996). https://doi.org/10.1007/BF00298567
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DOI: https://doi.org/10.1007/BF00298567