Affiliation:
1. Centro Hospitalar São João, Porto, Portugal - Department of Neurosurgery. Faculty of Medicine of the University of Porto, Portugal - Department of Clinical Neurosciences and Mental Health
Abstract
Background: The association between epidural fibrosis and recurrent symptoms after
lumbar spine surgery remains a matter of debate in scientific literature and the underlying
pathophysiological mechanism has not been clearly elucidated.
Objective: To investigate the presence of nerve fibers and the expression of osteopontin
in epidural fibrous tissue after lumbar surgery in humans.
Study Design: Laboratory study of human tissue samples.
Methods: Twenty-four patients with persistent or recurrent low back and/or leg pain after
lumbar spine surgery, in whom no relevant findings were present on magnetic resonance
imaging (MRI) besides epidural scar tissue, were submitted to epiduroscopy. Biopsy
samples of epidural scar tissue resting in the posterior epidural and periradicular space
were obtained from 15 patients, using an endoscopic grasping forceps, in locations where
the stimulation with the tip of a Fogarty consistently reproduced pain. Biopsy samples
were processed for examination under optical and transmission electron microscopes and
under a fluorescence microscope after incubation in primary antibodies against beta3-
tubulin or against osteopontin.
Results: Optical and transmission electron microscopy revealed a homogeneous fibrous
tissue rich in collagen and lacking nerve fibers. No immunofluorescence was present in
any of the samples immunoreacted against beta3-tubulin. In the samples immunoreacted
against osteopontin, a punctate signal was detected around the collagen fibers.
Limitations: Being a human study, there was no control group, so it is not possible to
determine the contribution of osteopontin in the formation of epidural fibrosis and its
relation to the patients’ symptoms. Additional animal studies are needed to investigate
these issues.
Conclusion: Rather than direct stimulation of nociceptors in the epidural scar tissue,
other factors should relate epidural fibrosis and recurrent symptoms after lumbar spine
surgery. Osteopontin seems to play a role in the formation of epidural fibrosis.
Key words: Osteopontin, failed back surgery syndrome, epidural fibrosis,
immunofluorescence, beta3-tubulin, epiduroscopy, nerve fibers, lumbar surgery
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
6 articles.
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