Epidural fibrosis is one of the most common causes of failed lumbar spinal back surgery and back surgery syndrome. Symptoms include moderate to severe back pain, including sciatic nerve issues, with no discernible herniation or other medical cause. Effective treatment to cure the condition has been elusive. Treatment targets reducing pain levels.
Pain triggered by epidural fibrosis is significant and can progress enough over time to become disabling. The pain is chronic and typically fails to respond to the usual treatments for back pain. Physical therapy and prescribed medications provide little to no relief for the condition. Movement exacerbates the condition, leading patients to curtail daily activities. In some cases, the patient becomes completely bedridden.
The type of surgery required by patients sets the stage for their risk of developing epidural fibrosis. Three to 14 percent of patients undergoing surgery for a prolapsed intervertebral disc will continue to have back pain following surgery, which can result in a diagnosis of this condition. Only 1 to 2 percent of patients undergoing a discectomy develop the condition.
No long-term, effective treatment for epidural fibrosis has been developed. Treatment protocol targets pain reduction if complete relief is not achievable. Research has shown a measure of success using antioxidants, specifically vitamin E. Narcotic pain medications do not typically provide complete relief; however, they are sometimes helpful in reducing the severity of pain.
The development of scar tissue in post-operative back surgery patients has proven to be insignificant to the development of epidural fibrosis. Many patients develop scar tissue along nerve roots following their surgery and do not develop the condition. An exception is when the scar tissue binds around the nerve root at the lumbar and also develops fibrous lesions. Overall, 90 percent of back surgeries are successful, with 10 percent developing post-operative back pain.
In most cases of epidural fibrosis, the patient enjoys six to 12 weeks of post-operative pain relief before the problem begins. It starts with a slowly developing pain in the leg or back. Continued pain at three months after surgery indicates that fibrosis may be present and, if so, the pain will likely increase in intensity and become chronic. In other cases, the pain is caused from an original misdiagnosis of the back injury. A condition called arachnoiditis is often mistaken for epidural fibrosis, making it important to get a proper diagnosis and treatment plan in place.