Natural products for preventing post-laminectomy epidural fibrosis: direct preclinical evidence, local delivery strategies, and translational gaps

Abstract Background Epidural fibrosis is a common complication of laminectomy, with symptomatic disease affecting up to 30% of patients after lumbar surgery. Excessive scar formation around the dura mater and nerve roots may contribute to recurrent radicular pain and failed back surgery syndrome, while corticosteroids, non-steroidal anti-inflammatory drugs, autologous fat grafting, and barrier materials provide inconsistent protection. Main body This focused narrative review evaluates natural bioactive compounds and biomaterial-based delivery systems for preventing post-laminectomy epidural fibrosis (PLEF). A structured search of PubMed, Scopus, Google Scholar, and Wiley Online Library prioritised English-language original research published between 2021 and 2026, while retaining older foundational and direct laminectomy studies. Curcumin, resveratrol, honey preparations, hesperidin, coenzyme Q10, and vitamin E have shown antifibrotic activity in experimental laminectomy models through modulation of TGF-β1/Smad signalling, inflammatory pathways, oxidative stress, fibroblast-to-myofibroblast transition, and collagen deposition. Apigenin, epigallocatechin-3-gallate, quercetin, bromelain, and Aloe vera remain indirect candidates supported mainly by non-laminectomy fibrosis or adhesion models. Injectable hydrogels and biodegradable scaffolds may strengthen these therapies by improving local retention, enabling sustained release, and providing a temporary anti-adhesion barrier. However, the evidence remains dominated by small, heterogeneous rodent studies, and radiological reductions in fibrosis have not consistently translated into improved pain or disability. Conclusion Natural products integrated with advanced local-delivery systems represent a promising strategy for PLEF prevention, but standardised models, neural-safety testing, large-animal validation, and patient-centred clinical trials are required before routine clinical use.