BACKGROUND: Complications reported from percutaneous disc decompression (PDD) include discitis, anaphylaxis (with chemonucleolysis), instability, increased back pain, and reherniation. To the best of our knowledge, there is no report of epidural fibrosis occurring with any of the many types of PDD. OBJECTIVE: To document a case of epidural fibrosis following PDD with coblation technology (Nucleoplasty), a previously unreported complication of this procedure. DESIGN: Case report. METHODS: Details are presented on a 46-year-old man's history, diagnostic test results, treatments, and progression of his symptoms. RESULTS: Following PDD with coblation technology at L5-S1, the patient noticed improvement in his left lower extremity radicular symptoms and low back pain. He continued to improve over the following week to near complete relief. He resumed his normal activities. Three months post treatment, he experienced a recurrence of his radicular pain with a diminished left Achilles reflex. A subsequent MRI showed improvement of the previous left paracentral protrusion at L5-S1 along with a new contrast enhancing soft tissue mass. This mass, consistent with epidural fibrosis, was located in the left antero-lateral spinal canal and encased the left S1 nerve root. On the patient's next follow-up visit, he reported spontaneous resolution in his symptoms. He had stopped all pain medications and returned to his usual activities. CONCLUSION: This case is the first reported occurrence of epidural fibrosis following percutaneous lumbar disc decompression.
BACKGROUND: Complications reported from percutaneous disc decompression (PDD) include discitis, anaphylaxis (with chemonucleolysis), instability, increased back pain, and reherniation. To the best of our knowledge, there is no report of epidural fibrosis occurring with any of the many types of PDD. OBJECTIVE: To document a case of epidural fibrosis following PDD with coblation technology (Nucleoplasty), a previously unreported complication of this procedure. DESIGN: Case report. METHODS: Details are presented on a 46-year-old man's history, diagnostic test results, treatments, and progression of his symptoms. RESULTS: Following PDD with coblation technology at L5-S1, the patient noticed improvement in his left lower extremity radicular symptoms and low back pain. He continued to improve over the following week to near complete relief. He resumed his normal activities. Three months post treatment, he experienced a recurrence of his radicular pain with a diminished left Achilles reflex. A subsequent MRI showed improvement of the previous left paracentral protrusion at L5-S1 along with a new contrast enhancing soft tissue mass. This mass, consistent with epidural fibrosis, was located in the left antero-lateral spinal canal and encased the left S1 nerve root. On the patient's next follow-up visit, he reported spontaneous resolution in his symptoms. He had stopped all pain medications and returned to his usual activities. CONCLUSION: This case is the first reported occurrence of epidural fibrosis following percutaneous lumbar disc decompression.
Authors: Shahed Tish; Ghaith Habboub; Hamid Borghei-Razavi; Troy D Woodard; Raj Sindwani; Varun R Kshettry; Pablo F Recinos Journal: J Neurol Surg B Skull Base Date: 2021-03-09