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Peridural Fibrosis
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Epidural fibrosis, epidural scar
              • Definitions

                • Scar formation within epidural space after lumbar surgery
                • Part of failed back surgery syndrome (FBSS)

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nonvascular Interventions

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Pereira P et al: New insights from immunohistochemistry for the characterization of epidural scar tissue. Pain Physician. 17(5):465-74, 2014
                                              2. Willson MC et al: Postoperative spine complications. Neuroimaging Clin N Am. 24(2):305-26, 2014
                                              3. Rönnberg K et al: Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients. Eur Spine J. 17(12):1714-20, 2008
                                              4. Ganzer D et al: Two-year results after lumbar microdiscectomy with and without prophylaxis of a peridural fibrosis using Adcon-L. Arch Orthop Trauma Surg. 123(1):17-21, 2003
                                              5. Van Goethem JW et al: Review article: MRI of the postoperative lumbar spine. Neuroradiology. 44(9):723-39, 2002
                                              6. Anderson SR: A rationale for the treatment algorithm of failed back surgery syndrome. Curr Rev Pain. 4(5):395-406, 2000
                                              7. Anderson VC et al: Failed back surgery syndrome. Curr Rev Pain. 4(2):105-11, 2000
                                              8. Coskun E et al: Relationships between epidural fibrosis, pain, disability, and psychological factors after lumbar disc surgery. Eur Spine J. 9(3):218-23, 2000
                                              9. Pearce JM: Aspects of the failed back syndrome: role of litigation. Spinal Cord. 38(2):63-70, 2000
                                              10. Samy Abdou M et al: Epidural fibrosis and the failed back surgery syndrome: history and physical findings. Neurol Res. 21 Suppl 1:S5-8, 1999
                                              11. Fritsch EW et al: The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine. 21(5):626-33, 1996
                                              12. Georgy BA et al: Fat-suppression contrast-enhanced MRI in the failed back surgery syndrome: a prospective study. Neuroradiology. 37(1):51-7, 1995
                                              13. North RB et al: Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation. Neurosurgery. 28(5):685-90; discussion 690-1, 1991
                                              14. Bundschuh CV et al: Distinguishing between scar and recurrent herniated disk in postoperative patients: value of contrast-enhanced CT and MR imaging. AJNR Am J Neuroradiol. 11(5):949-58, 1990
                                              15. Djukic S et al: Magnetic resonance imaging of the postoperative lumbar spine. Radiol Clin North Am. 28(2):341-60, 1990
                                              16. Ross JS et al: MR imaging of the postoperative lumbar spine: assessment with gadopentetate dimeglumine. AJNR Am J Neuroradiol. 11(4):771-6, 1990
                                              17. Ross JS et al: MR imaging of the postoperative lumbar spine: assessment with gadopentetate dimeglumine. AJR Am J Roentgenol. 155(4):867-72, 1990
                                              18. Hueftle MG et al: Lumbar spine: postoperative MR imaging with Gd-DTPA. Radiology. 167(3):817-24, 1988
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Epidural fibrosis, epidural scar
                                                          • Definitions

                                                            • Scar formation within epidural space after lumbar surgery
                                                            • Part of failed back surgery syndrome (FBSS)

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Nonvascular Interventions

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Pereira P et al: New insights from immunohistochemistry for the characterization of epidural scar tissue. Pain Physician. 17(5):465-74, 2014
                                                                                          2. Willson MC et al: Postoperative spine complications. Neuroimaging Clin N Am. 24(2):305-26, 2014
                                                                                          3. Rönnberg K et al: Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients. Eur Spine J. 17(12):1714-20, 2008
                                                                                          4. Ganzer D et al: Two-year results after lumbar microdiscectomy with and without prophylaxis of a peridural fibrosis using Adcon-L. Arch Orthop Trauma Surg. 123(1):17-21, 2003
                                                                                          5. Van Goethem JW et al: Review article: MRI of the postoperative lumbar spine. Neuroradiology. 44(9):723-39, 2002
                                                                                          6. Anderson SR: A rationale for the treatment algorithm of failed back surgery syndrome. Curr Rev Pain. 4(5):395-406, 2000
                                                                                          7. Anderson VC et al: Failed back surgery syndrome. Curr Rev Pain. 4(2):105-11, 2000
                                                                                          8. Coskun E et al: Relationships between epidural fibrosis, pain, disability, and psychological factors after lumbar disc surgery. Eur Spine J. 9(3):218-23, 2000
                                                                                          9. Pearce JM: Aspects of the failed back syndrome: role of litigation. Spinal Cord. 38(2):63-70, 2000
                                                                                          10. Samy Abdou M et al: Epidural fibrosis and the failed back surgery syndrome: history and physical findings. Neurol Res. 21 Suppl 1:S5-8, 1999
                                                                                          11. Fritsch EW et al: The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine. 21(5):626-33, 1996
                                                                                          12. Georgy BA et al: Fat-suppression contrast-enhanced MRI in the failed back surgery syndrome: a prospective study. Neuroradiology. 37(1):51-7, 1995
                                                                                          13. North RB et al: Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation. Neurosurgery. 28(5):685-90; discussion 690-1, 1991
                                                                                          14. Bundschuh CV et al: Distinguishing between scar and recurrent herniated disk in postoperative patients: value of contrast-enhanced CT and MR imaging. AJNR Am J Neuroradiol. 11(5):949-58, 1990
                                                                                          15. Djukic S et al: Magnetic resonance imaging of the postoperative lumbar spine. Radiol Clin North Am. 28(2):341-60, 1990
                                                                                          16. Ross JS et al: MR imaging of the postoperative lumbar spine: assessment with gadopentetate dimeglumine. AJNR Am J Neuroradiol. 11(4):771-6, 1990
                                                                                          17. Ross JS et al: MR imaging of the postoperative lumbar spine: assessment with gadopentetate dimeglumine. AJR Am J Roentgenol. 155(4):867-72, 1990
                                                                                          18. Hueftle MG et al: Lumbar spine: postoperative MR imaging with Gd-DTPA. Radiology. 167(3):817-24, 1988