Abstract
Introduction: Peridural fibrosis is a reaction that occurs outside the dura and occurs in the healing process following lumber surgery1.The fibrosis is recognised as one of the possible causes of the failed back syndrome following lumbar spinal surgery. ADCON-L Anti-Adhesion Barrier Gel has been shown to be of Benefit in patients undergoing discectomy in reducing symptomatic fibrosis. The aim of this prospective study is to elicit the advantages and potential risks of using ADCON-L in more extensive decompression procedures and in instrumented spinal fusions.
Method: ADCON-L anti-adhesion barrier gel, has been used in 288 patients undergoing the following surgeries: posterior lumbar interbody fusion (PLIF) (49), decompression and instrumented fusion posterior interbody supplementary fixation (PISF) (96), decompression and Graf ligament stabilisation (31), decompression of stenosis (54), discectomy (41), and revision discectomy or decompression (17). Any adverse clinical events, including pseudarthrosis, new, recurrent or deteriorating leg pain, paraesthesia or neurological deficit, were documented. Patients with neurological symptoms suggestive of fibrosis including deteriorating leg pain were evaluated with an MRI scan with gadolinium enhancement. Fusion rates were evaluated where appropriate.
Results: Two patients developed significant early (< 4 weeks) recurrent sciatica. MRI demonstrated a recurrent disc prolapse at the same level in one patient, who required re-operation, but no fibrosis was noted at the surgery. Late developing leg pain occurred in 16 patients. All these patients were evaluated with MRI with gadolinium enhancement. Independent radiological assessment indicated the principal cause of the leg pain to be peridural fibrosis in 9 patients (3.1%). Other causes included recurrent disc prolapse or lateral recess stenosis. Early post-operative wound seepage or superficial wound infections occurred in 5 (1.7%). There were no late infections. Two patients developed a postoperative pseudomeningocoele. One required re-exploration and repair, the other settled with conservative treatment. At review 1 to 4 years (mean 2.7 years) after undergoing PISF and PLIF fusion had achieved in 93.1% of cases.
Discussion: Previous prospective randomised multi-centre studies have shown the effectiveness of ADCON-L gel in reducing peridural fibrosis in patients following discectomy. Our study shows that there is low incidence of peridural fibrosis and associated leg pain when ADCON-L is used in all forms of degenerative lumbar spine surgery. There is a low complication rate and good fusion rate.
The abstracts were prepared by I. B. McPhee. Correspondence should be addressed to the Spine Society of Australia Secretariat, The Adelaide Centre for Spinal Research, Institute of Medical and Veterinary Science, PO Box 14, Rundle Mall, Adelaide SA 5000, Australia.
