Peridural scar

see Epidural Fibrosis

Also known as:

• Epidural scarring
• Postoperative epidural adhesions
• (Less commonly: Peridural fibrosis / scar)

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.

• 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.

• 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

• 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

• 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

• Neuropathic pain medications (gabapentin, pregabalin, duloxetine)
• Epidural steroid injections (limited efficacy in dense fibrosis)
• Physical therapy and pain education

• Adhesiolysis procedures (e.g., Racz catheter)
• Spinal cord stimulation (SCS)
• Surgical revision only in carefully selected cases

• Minimize dissection and bleeding
• Preserve epidural fat when possible
• Barrier gels (e.g., ADCON-L) have been studied but remain controversial

• postlaminectomy_syndrome
• recurrent_disc_herniation
• spinal_cord_stimulation

• 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.