Prevention of peridural fibrosis: current methodologies

Abstract

Lumbar discectomy is a common surgical procedure with a physician-reported 'good' outcome of 85%-95% for successfully relieving pre-operative sciatic pain. Up to 40% of patients post-operatively, however, have persistent limitations in activity. Peridural fibrosis is a natural consequence of the normal post-operative healing that can cause symptoms by tethering the nerve roots. ADCON-L was developed to decrease the peridural fibrosis reaction. Cell culture analysis demonstrated that ADCON-L blocked the ingrowth of fibroblasts, and animal laminectomy models demonstrated a major decrease in the amount of peridural fibrosis. ADCON-L has been studied in two prospective randomized multicenter trials, one in Europe with 298 patients and the other in the United States with 223 patients at the interim analysis. Noting the differences in the quantity of peridural scar on post-operative MRI and in clinical outcome between the two groups assessed the effect of the addition of ADCON-L to the surgical procedure. Both studies had statistically significant positive beneficial effects in both the radiologic index and the clinical outcome scores. These two studies provide the evidence for the clinical use of ADCON-L to improve outcomes after lumbar discectomy.