Postoperative Epidural Fibrosis after Lumbar Disc Herniation Surgery: Our Experience

Abstract

Purpose

Postoperative epidural fibrosis (PEF) is a significant complication following lumbar disc herniation surgery. It is characterised by the formation of non-physiological scar tissue that may lead to recurrent radicular pain and contribute to failed back surgery syndrome (FBSS). Despite its clinical relevance, the exact incidence and effective management strategies for LPEF have not been adequately quantified in the existing literature.

Methods

This study analyses a cohort of 2673 patients who underwent surgical intervention for herniated lumbar discs between September 2010 and August 2023, focusing on 1974 patients monitored for up to one year post surgery.

Results

The study reports on the incidence of postoperative fibrosis, with 97 patients diagnosed with this condition. Over 61% of these patients experienced inadequate relief following various treatment modalities, including epidural steroid injections and anti-neuropathic medications.

Conclusion

The findings indicate that while corticosteroid injections provided relief for a minority (23.61%) of patients, a substantial proportion continued to experience pain, necessitating referral to pain management centres. This research contributes to the understanding of LPEF’s impact on patient outcomes and underscores the need for further investigation into effective preventive and therapeutic strategies during postoperative care.

Zusammenfassung

Hintergrund

Die lumbale postoperative epidurale Fibrose (LPEF) stellt eine bedeutende Komplikation nach Operationen bei lumbalen Bandscheibenvorfällen dar. Sie ist durch die Bildung von nicht-physiologischem Narbengewebe gekennzeichnet und kann zu rezidivierenden radikulären Schmerzen sowie zum sog. „Failed-Back-Surgery-Syndrom“ (FBSS) führen. Trotz ihrer klinischen Relevanz sind sowohl die Inzidenz als auch effektive Therapien in der Literatur bislang unzureichend dokumentiert.

Methoden

In dieser Studie wurden 2673 Patienten untersucht, die zwischen September 2010 und August 2023 aufgrund eines lumbalen Bandscheibenvorfalls operiert wurden. Insgesamt wurden 1974 dieser Patienten bis zu einem Jahr postoperativ nachverfolgt.

Ergebnisse

Bei 97 Patienten wurde eine postoperative Fibrose diagnostiziert. Über 61% der Betroffenen berichteten von einer unzureichenden Schmerzlinderung trotz verschiedener nicht operativer Behandlungsansätze, darunter periradikuläre Steroidinjektionen und antineuropathische Medikamente.

Schlussfolgerung

Während bei einem Teil der Patienten (23,61%) eine Besserung durch Steroidinjektionen erreicht werden konnte, litten die meisten weiterhin unter Schmerzen, wodurch eine Überweisung an Schmerztherapiezentren erforderlich wurde. Diese Arbeit unterstreicht die Bedeutung der LPEF und den dringenden Bedarf an verbesserten Präventions- und Behandlungsstrategien in der postoperativen Versorgung.

Keywords

low back pain - spine surgery - epidural injection

Schlüsselwörter

Rückenschmerzen - Wirbelsäulenchirurgie - epidurale Steroidinfiltration

Publication History

Received: 07 May 2025

Accepted after revision: 22 December 2025

Article published online:
30 January 2026

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