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What Is Epidural Fibrosis?

By C. Webb
Updated Mar 03, 2024
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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.

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Discussion Comments

By anon993393 — On Nov 11, 2015

I currently am undergoing diagnosis for what I believe are symptoms of epidural fibrosis. From what I see, things like three months post op experiencing sciatic pain in my right leg. It starts with pressure in my lower back, then runs down and locks in my knee.

My history was with an L5-S1 discectomy earlier this year. It has impacted my ability to work and now a work related injury has exacerbated my preexisting condition which has been worsening. I have a second orthopedic specialist after my primary didn't want to work with me anymore. They were making it hard and I felt they thought I was making it up. Now with the second orthopedic specialist, I get a deer in the headlights look. I mentioned all the related issues to possibly identifying this with epidural fibrosis and he has strongly ruled that would be unlikely but we are awaiting the MRI with contrast.

It's been frustrating, but my primary care physician (family doctor) seems to be the best to work with in identifying this as a chronic condition based on all the information she has been given. She has shared information from day one before my surgery and she assisted me with ADA and FMLA paperwork. So what I can say is hopefully, your family doctors can assist and you would initially have to give them rights to access all information when the process begins of filing paperwork from the very beginning.

Hopefully, I'll have some diagnosis in a week or so. All I know is it's impacting every part of me mentally and physically. I already submitted SSI paperwork as a possible alternative due to the fact I have missed so much work and lost pay. If some conditions are labeled as chronic, one may benefit.

By anon976583 — On Nov 04, 2014

I was just diagnosed with this condition following L5-S1 microdiscectomy. I had sciatic pain relief for roughly five weeks, then the sciatic pain set in again, but it was different than the original pain caused by my intensely herniated disc -- a shooting pain from my foot and inner thigh accompanied by a pinching feeling in my back, as opposed to primarily lower back and upper leg sciatic pain experienced prior to the operation. An MRI with contrast dye revealed scar tissue bonding to my left sciatic nerve and the treatment prescribed was intense physical therapy for four weeks focusing on breaking up the scar tissue and liberating the nerve root from the scar tissue.

I am one week into therapy and am currently in constant, intense pain ranging from sharp back, leg and foot pain to total numbness and the only thing that works to relieve it is painkillers, and that only dulls it mildly. I am unable to work the way I usually do, and cannot focus on anything but the pain, which seems to be as bad if not worse than prior to the operation. If anyone has any insight about this condition I would love to hear it. Reading that there is no proven long term fix for this worries me intensely as I am a very physical person and getting back to being myself requires some kind of long term pain management strategy that is not simply being doped out on painkillers all the time. Thanks, Dave

By anon947081 — On Apr 24, 2014

I had a left side l5-s1 discectomy four years ago. The surgeon told me he took out a thumbnail sized chunk and he didn’t even need to cut it; it just pulled right out. It still hurts there and I had leg spasms for six months.

I felt better for two more months and then it started again. It is very painful sometimes. I just drag my left leg because I can’t use it. My last MRI through free county healthcare clearly showed a large 6-10 mm protrusion and a substance "likely representing epidural fibrosis". My NP doctor said, “Your MRI doesn’t show anything pressing on the nerve.” I told her I'm not making it up. She prescribed me medication like amitryptoline and nuerontin, and another one, all of which had horrible side effects. My question is what is the next stage for diagnosis of my condition? A contrast dye MRI or some other kind of scan? What can I get them to do to help diagnose me properly so we can come up with a plan to treat the fibrosis that I "supposedly" have? Thanks for any help or advice. --Jim

By Axeleye — On Feb 03, 2014

That sounds awful! I have researched chronic back pain, are there really no remedies or physical therapies that can reduce pain from this condition? I read about a number of exercises for chronic back pain, so I was curious if any applied.

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