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--- peridural_scar [2025/07/03 16:57] – administrador
+++ peridural_scar [2025/07/03 16:57] (current) – administrador
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 see [[Epidural Fibrosis]]
-**Also known as:**
-  * Epidural scarring
-  * Postoperative epidural adhesions
-  * ''(Less commonly: Peridural fibrosis / scar)''
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-=== 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]].
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-=== 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.
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-=== 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**
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-=== 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
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-=== 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
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-=== 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
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-=== Prevention ===
-  * Minimize dissection and bleeding
-  * Preserve epidural fat when possible
-  * Barrier gels (e.g., ADCON-L) have been studied but remain controversial
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-=== See Also ===
-  * [[postlaminectomy_syndrome]]
-  * [[recurrent_disc_herniation]]
-  * [[spinal_cord_stimulation]]
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-=== References ===
-  * Ross JS et al. Imaging of epidural fibrosis: MRI-pathologic correlation. ''AJNR Am J Neuroradiol''. 1992.
-  * North RB et al. Spinal cord stimulation versus reoperation for failed back surgery syndrome. ''Neurosurgery''. 2005.
-  * Burton CV. Causes of failure of surgery on the lumbar spine: ten-year follow-up. ''Orthop Clin North Am''. 1971.