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Clinical outcomes associated with drug-soaked acellular dermal matrix after biportal endoscopic lumbar surgery: a retrospective comparative study

Year: 2026

Type: article

Abstract: PURPOSE: To evaluate the clinical outcomes associated with epidurally applied acellular dermal matrix (ADM) soaked with dexamethasone or fentanyl following biportal endoscopic lumbar surgery (BESS). METHODS: This retrospective comparative study included 90 patients who underwent lumbar decompression or discectomy using BESS. Patients were divided into three groups according to intraoperative epidural management: a control group without ADM, an ADM group soaked with dexamethasone and an ADM group soaked with fentanyl. Postoperative pain scores, IV PCA usage, laboratory inflammatory markers including IL-6, functional outcomes, and postoperative medication use were compared among groups. RESULTS: Baseline demographic and surgical characteristics were comparable among groups. Both ADM groups demonstrated earlier IV PCA discontinuation and greater residual PCA volume at discontinuation compared with the control group. The fentanyl-soaked ADM group showed greater reductions in postoperative pain scores and a shorter hospital stay. IL-6 levels were significantly lower in the dexamethasone-soaked ADM group on postoperative days 2 and 3. While ODI scores improved similarly across all groups, both ADM groups demonstrated differences in early patient-reported recovery outcomes on SF-36 assessments. CONCLUSION: Use of drug-soaked ADM was associated with differences in acute postoperative pain scores, earlier IV PCA discontinuation, greater residual PCA reservoir volume at discontinuation, and improved early patient-reported recovery outcomes during the immediate postoperative period. These findings demonstrate associations between the use of drug-soaked ADM and the observed early postoperative clinical outcomes following biportal endoscopic lumbar surgery. Future prospective multicenter studies with longer follow-up are warranted to validate these findings and further clarify their long-term clinical significance.

Source: BMC Musculoskeletal Disorders

DOI: 10.1186/s12891-026-10336-8