Prevention of epidural fibrosis in a prospective series of 100 primary lumbo-sacral discectomy patients: Follow-up and assessment at re-operation

An implantable device (ADCON(R)-L), which acts as a resorbable barrier to epidural fibrosis following lumbar discectomy, has been shown to minimize the formation of peridural fibrotic scar and to improve the post-operative outcome, in two large controlled and multi-center clinical trials. In this prospective study, 100 patients were treated with the device during their first-time lumbo-sacral discectomy surgeries and monitored for 12 months. During this time interval, four of these patients required re-operation. In these cases, epidural scar and ease of dissection were systematically evaluated and recorded. At the time of reoperation, in all four patients, absent or minimal soft scar tissue was found where ADCON(R)-L had been placed, no adhesions to the involved root were observed and the dissection was easier than expected; the healing of the surgical wound was excellent, and no residual implant material was found. These observations indicate that the use of ADCON(R)-L at the time of the first lumbar disc surgery minimizes the hazards and difficulty that can be encountered in a subsequent revision surgery due to the presence of epidural fibrosis, and may therefore improve the chances of satisfactory outcome following re-operation.