Postoperative Epidural Fibrosis: Challenges and Opportunities - A Review

Guido Lewik; Gerrit Lewik; Lena S. Müller; Alexander von Glinski; Tobias L. Schulte; Tobias Lange

doi:10.22603/ssrr.2023-0106

REVIEW ARTICLE

Postoperative Epidural Fibrosis: Challenges and Opportunities - A Review

Guido Lewik, Gerrit Lewik, Lena S. Müller, Alexander von Glinski, Tobias L. Schulte, Tobias Lange

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Keywords: Epidural Fibrosis, Peridural Fibrosis, Epidural Adhesions, Peridural Adhesions, Laminectomy, Failed Back Surgery Syndrome, Epiduroscopy, Epidural Adhesiolysis, Epidurolysis

JOURNAL OPEN ACCESS

2024 Volume 8 Issue 2 Pages 133-142

DOI https://doi.org/10.22603/ssrr.2023-0106

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Abstract

Postoperative epidural fibrosis (EF) is still a major limitation to the success of spine surgery. Fibrotic adhesions in the epidural space, initiated via local trauma and inflammation, can induce difficult-to-treat pain and constitute the main cause of failed back surgery syndrome, which not uncommonly requires operative revision.

Manifold agents and methods have been tested for EF relief in order to mitigate this longstanding health burden and its socioeconomic consequences. Although several promising strategies could be identified, few have thus far overcome the high translational hurdle, and there has been little change in standard clinical practice. Nonetheless, notable research progress in the field has put new exciting avenues on the horizon.

In this review, we outline the etiology and pathogenesis of EF, portray its clinical and surgical presentation, and critically appraise current efforts and novel approaches toward enhanced prevention and treatment.

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