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--- epidural_fibrosis [2025/07/03 16:56] – administrador
+++ epidural_fibrosis [2025/07/03 16:57] (current) – administrador
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 ====== Epidural fibrosis ======
+**Also known as:**
+  * Epidural scarring
+  * Postoperative epidural adhesions
+  * ''(Less commonly: Peridural fibrosis / scar)''
+----
+=== Definition ===
+**[[Epidural fibrosis]]** refers to the formation of **fibrous tissue in the epidural space** following spinal surgery, particularly laminectomy or discectomy. It may lead to **nerve root tethering**, **chronic radicular pain**, and contribute to [[postlaminectomy_syndrome]].
+----
+=== Terminology Note ===
+  * The term '''epidural fibrosis''' is the **standard** in clinical and radiological literature.
+  * '''Epidural scarring''' is widely accepted in informal or descriptive contexts.
+  * '''Peridural scar/fibrosis''' is anatomically correct (peri- = around the dura) but is **rarely used** in modern publications or radiology reports.
+----
+=== Pathophysiology ===
+  * Develops as part of the **normal wound healing response**
+  * Fibrous tissue may envelop or tether nerve roots
+  * Can restrict nerve root movement and cause **mechanical or inflammatory pain**
+----
+=== Clinical Relevance ===
+  * Common cause of persistent radicular pain after surgery
+  * Often associated with [[postlaminectomy_syndrome]]
+  * Pain is typically neuropathic, burning, or shooting
+  * Motor deficits are uncommon unless scar is severe or combined with recurrent disc
+----
+=== Imaging ===
+  * **MRI with contrast** is the modality of choice
+    * Epidural fibrosis: enhances uniformly
+    * Recurrent disc: non-enhancing or peripheral enhancement
+  * May show nerve root entrapment or dural sleeve distortion
+  * CT myelography as an alternative if MRI contraindicated
+----
+=== Treatment Options ===
+==== Conservative ====
+  * Neuropathic pain medications (gabapentin, pregabalin, duloxetine)
+  * Epidural steroid injections (limited efficacy in dense fibrosis)
+  * Physical therapy and pain education
+==== Interventional ====
+  * Adhesiolysis procedures (e.g., Racz catheter)
+  * [[spinal_cord_stimulation|Spinal cord stimulation (SCS)]]
+  * Surgical revision only in carefully selected cases
+----
+=== Prevention ===
+  * Minimize dissection and bleeding
+  * Preserve epidural fat when possible
+  * Barrier gels (e.g., ADCON-L) have been studied but remain controversial
+----
 ===== General information =====