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Lewik G, Lewik G, Müller LS, von Glinski A, Schulte TL, Lange T. Postoperative Epidural Fibrosis: Challenges and Opportunities - A Review. Spine Surg Relat Res 2024; 8:133-142. [PMID: 38618214 PMCID: PMC11007250 DOI: 10.22603/ssrr.2023-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 04/16/2024] Open
Abstract
Postoperative epidural fibrosis (EF) is still a major limitation to the success of spine surgery. Fibrotic adhesions in the epidural space, initiated via local trauma and inflammation, can induce difficult-to-treat pain and constitute the main cause of failed back surgery syndrome, which not uncommonly requires operative revision. Manifold agents and methods have been tested for EF relief in order to mitigate this longstanding health burden and its socioeconomic consequences. Although several promising strategies could be identified, few have thus far overcome the high translational hurdle, and there has been little change in standard clinical practice. Nonetheless, notable research progress in the field has put new exciting avenues on the horizon. In this review, we outline the etiology and pathogenesis of EF, portray its clinical and surgical presentation, and critically appraise current efforts and novel approaches toward enhanced prevention and treatment.
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Affiliation(s)
- Guido Lewik
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Gerrit Lewik
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Lena S Müller
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Alexander von Glinski
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Tobias L Schulte
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Tobias Lange
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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Villanova Junior JA, Magalhães MAB, Cereja de Souza TD, Battisti MKB, Engracia Filho JR, Pimpão CT, Müeller MO, Arruda PD, Capriglione LGA. Polypropylene mesh inhibits post-laminectomy compressive scar formation in rabbits: Histopathological and computational morphometric evaluation. Neurosci Lett 2021; 760:135973. [PMID: 34023408 DOI: 10.1016/j.neulet.2021.135973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/14/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
We evaluated the effect of polypropylene mesh placement on post-laminectomy compressive scar formation in rabbits. Twenty-two white male New Zealand rabbits were distributed into two groups (n = 11). In the control group, the animals underwent lumbosacral laminectomy, whereas in the mesh group, the rabbits were submitted to lumbosacral laminectomy followed by the attachment of a polypropylene mesh to the vertebrae by the application of N-butyl cyanoacrylate. After eight weeks, the rabbits were euthanized, and the laminectomy area was collected for macro- and microscopic analyses. Macroscopically, we evaluated the (1) vertebral canal height; (2) laminectomy width and (3) length; and (4) fibrosis width, (5) height, and (6) length. Microscopically, we evaluated (7) fibroblasts; (8) the thickness of the dura-mater; and (9) the distance between the dura-mater and the laminectomy area. Macroscopically, there were no differences between the groups regarding vertebral canal height; width and length of the laminectomy; and fibrosis width. However, the height, and length of fibrosis were smaller in the mesh group. Microscopically, there were no differences in dura mater thickness and the distance between the dura mater and laminectomy area, but fewer fibroblasts were observed in the mesh group. This indicated that the polypropylene mesh improved tissue repair, with greater tissue organization. The results demonstrate that the use of a polypropylene mesh in the treatment of post-laminectomy wounds in rabbits reduces the severity of compressive fibrous scar formation. Polypropylene mesh is presented as a good alternative to reduce complications associated with laminectomy surgeries.
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Affiliation(s)
| | - Maria Angélica B Magalhães
- Graduate Program in Animal Science at Pontifícia Universidade Católica do Paraná - PUCPR, Curitiba, Brazil
| | - Tainah D Cereja de Souza
- Graduate Program in Animal Science at Pontifícia Universidade Católica do Paraná - PUCPR, Curitiba, Brazil
| | | | - Jair Rodini Engracia Filho
- Graduate Program in Animal Science at Pontifícia Universidade Católica do Paraná - PUCPR, Curitiba, Brazil
| | - Cláudia T Pimpão
- Graduate Program in Animal Science at Pontifícia Universidade Católica do Paraná - PUCPR, Curitiba, Brazil
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Li X, Chen S, Yan L, Wang J, Pei M. Prospective application of stem cells to prevent post-operative skeletal fibrosis. J Orthop Res 2019; 37:1236-1245. [PMID: 30835890 PMCID: PMC9202416 DOI: 10.1002/jor.24266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/17/2019] [Indexed: 02/04/2023]
Abstract
Post-operative skeletal fibrosis is considered one of the major complications causing dysfunction of the skeletal system and compromising the outcomes of clinical treatment. Limited success has been achieved using current therapies; more effective therapies to reduce post-operative skeletal fibrosis are needed. Stem cells possess the ability to repair and regenerate damaged tissue. Numerous studies show that stem cells serve as a promising therapeutic approach for fibrotic diseases in tissues other than the skeletal system by inhibiting the inflammatory response and secreting favorable cytokines through activating specific signaling pathways, acting as so-called medicinal signaling cells. In this review, current therapies are summarized for post-operative skeletal fibrosis. Given that stem cells are used as a promising therapeutic approach for fibrotic diseases, little effort has been undertaken to use stem cells to prevent post-operative skeletal fibrosis. This review aims at providing useful information for the potential application of stem cells in preventing post-operative skeletal fibrosis in the near future. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1236-1245, 2019.
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Affiliation(s)
- Xiaolei Li
- Department of Orthopaedics, Orthopaedics Institute, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China,Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, Morgantown, WV, 26506, USA
| | - Song Chen
- Department of Orthopaedics, Chengdu Military General Hospital, Chengdu, Sichuan, 610083, China
| | - Lianqi Yan
- Department of Orthopaedics, Orthopaedics Institute, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Jingcheng Wang
- Department of Orthopaedics, Orthopaedics Institute, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China,Co-Corresponding author: Jingcheng Wang, MD, Department of Orthopaedics, Subei People’s Hospital, 98 West Nantong Road, Yangzhou 225001, China;
| | - Ming Pei
- Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, Morgantown, WV, 26506, USA,Exercise Physiology, West Virginia University, Morgantown, WV, 26506, USA,WVU Cancer Institute, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV, 26506, USA,Corresponding author: Ming Pei MD, PhD, Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, PO Box 9196, 64 Medical Center Drive, Morgantown, WV 26506-9196, USA, Telephone: 304-293-1072; Fax: 304-293-7070;
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Zeng L, Sun Y, Li X, Wang J, Yan L. 10‑Hydroxycamptothecin induces apoptosis in human fibroblasts by regulating miRNA‑23b‑3p expression. Mol Med Rep 2019; 19:2680-2686. [PMID: 30720099 PMCID: PMC6423607 DOI: 10.3892/mmr.2019.9927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/28/2018] [Indexed: 11/18/2022] Open
Abstract
10-Hydroxycamptothecin (HCPT) effectively controls epidural fibrosis, but the exact underlying mechanisms remain ambiguous. Abnormal microRNA (miR)-23b-3p expression has been detected in various types of fibrotic tissues that are present in different diseases. The aim of the present study was to elucidate the mechanisms through which HCPT induces fibroblast apoptosis. Reverse transcription-quantitative polymerase chain reactions were performed on six traumatic scar samples and matched normal skin samples; traumatic scar formation was revealed to be significantly inversely associated with miR-23b-3p expression. In addition, the miR-23b-3p expression level in human fibroblasts was examined following HCPT treatment. The effects of HCPT and miR-23b-3p on fibroblast apoptosis were assessed using terminal deoxynucleotidyl-transferase-mediated dUTP nick-end labeling, flow cytometry and western blot analysis. The results demonstrated that HCPT treatment notably increased miR-23b-3p expression levels and accelerated fibroblast apoptosis. Therefore, upregulation of miR-23b-3p expression was demonstrated to promote fibroblast apoptosis, consistently with the effects of HCPT. The results of the present study indicated that HCPT may induce fibroblast apoptosis by regulating miR-23b-3p expression.
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Affiliation(s)
- Lingrong Zeng
- Department of Orthopedics, The Second Affiliated Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410012, P.R. China
| | - Yu Sun
- Orthopedic Institute, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Xiaolei Li
- Orthopedic Institute, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Jingcheng Wang
- Orthopedic Institute, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Lianqi Yan
- Department of Orthopedics, The Second Affiliated Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410012, P.R. China
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Kikuchi K, Setoyama K, Terashi T, Sumizono M, Tancharoen S, Otsuka S, Takada S, Nakanishi K, Ueda K, Sakakima H, Kawahara KI, Maruyama I, Hattori G, Morioka M, Tanaka E, Uchikado H. Application of a Novel Anti-Adhesive Membrane, E8002, in a Rat Laminectomy Model. Int J Mol Sci 2018; 19:ijms19051513. [PMID: 29783695 PMCID: PMC5983581 DOI: 10.3390/ijms19051513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022] Open
Abstract
Neuropathic pain after spinal surgery, so-called failed back surgery syndrome, is a frequently observed common complication. One cause of the pain is scar tissue formation, observed as post-surgical epidural adhesions. These adhesions may compress surrounding spinal nerves, resulting in pain, even after successful spinal surgery. E8002 is an anti-adhesive membrane. In Japan, a clinical trial of E8002 is currently ongoing in patients undergoing abdominal surgery. However, animal experiments have not been performed for E8002 in spinal surgery. We assessed the anti-adhesive effect of E8002 in a rat laminectomy model. The dura matter was covered with an E8002 membrane or left uncovered as a control. Neurological evaluations and histopathological findings were compared at six weeks postoperatively. Histopathological analyses were performed by hematoxylin–eosin and aldehyde fuchsin-Masson Goldner staining. Three assessment areas were selected at the middle and margins of the laminectomy sites, and the numbers of fibroblasts and inflammatory cells were counted. Blinded histopathological evaluation revealed that adhesions and scar formation were reduced in the E8002 group compared with the control group. The E8002 group had significantly lower numbers of fibroblasts and inflammatory cells than the control group. The present results indicate that E8002 can prevent epidural scar adhesions after laminectomy.
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Affiliation(s)
- Kiyoshi Kikuchi
- Division of Brain Science, Department of Physiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
- Department of Neurosurgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
- Department of Pharmacology, Faculty of Dentistry, Mahidol University, 6 Yothe Road, Rajthevee, Bangkok 10400, Thailand.
| | - Kentaro Setoyama
- Division of Laboratory Animal Science, Natural Science Center for Research and Education, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
| | - Takuto Terashi
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
| | - Megumi Sumizono
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
| | - Salunya Tancharoen
- Department of Pharmacology, Faculty of Dentistry, Mahidol University, 6 Yothe Road, Rajthevee, Bangkok 10400, Thailand.
| | - Shotaro Otsuka
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
| | - Seiya Takada
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
| | - Kazuki Nakanishi
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
| | - Koki Ueda
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
| | - Harutoshi Sakakima
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
| | - Ko-Ichi Kawahara
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
- Laboratory of Functional Foods, Department of Biomedical Engineering Osaka Institute of Technology, 5-16-1 Omiya, Asahi-ku, Osaka 535-8585, Japan.
| | - Ikuro Maruyama
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
| | - Gohsuke Hattori
- Department of Neurosurgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
| | - Eiichiro Tanaka
- Division of Brain Science, Department of Physiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
| | - Hisaaki Uchikado
- Department of Neurosurgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
- Uchikado Neuro-Spine Clinic, 1-2-3 Naka, Hakata-ku, Fukuoka 812-0893, Japan.
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Evaluation of topical Dexmedetomidine administration in postlaminectomy epidural fibrosis rat model. Int J Surg 2018; 53:80-85. [PMID: 29555523 DOI: 10.1016/j.ijsu.2018.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/29/2018] [Accepted: 03/11/2018] [Indexed: 02/06/2023]
Abstract
Epidural fibrosis is a challenging topic in spinal surgery. Numerous clinical and experimental studies have been focused on this issue to clarify problems faced in spinal procedures for the patient as well as the surgeon and find out new methodologies. Dense cytokines and growth factors which are released from inflammatory cells have been suggested to play a major role in the inception and progression of fibrosis. One of the most investigated and important actor in epidural fibrosis is assumed to be the transforming growth factor-1β (TGF-1β) formation. Studies showed that Dexmedetomidine (DEX) downregulates TGF-β pathway with its anti-inflammatory and antioxidant effects. From this point of view, for the first time in the literature we try to observe if there will be an effect of topical DEX administration over epidural fibrosis in a rat model. We hypothesized that DEX might have preventive effects on epidural fibrosis via anti-inflammatory and antioxidant effects. Twenty-four adult male Wistar albino rats were randomly assigned to three groups (Topical DEX, Spongostan, Laminectomy). A total laminectomy was performed at the L3-L5 level and then the ligamentum flavum and epidural fat tissue were cleared away from the surgical site. Histopathological assessment was performed postoperatively after 4 weeks. Our study revealed that topical DEX administration may have effects on reducing epidural fibrosis. Topical DEX administration may be helpful in preventing epidural fibrosis after laminectomy in rats through multiple anti-inflammatory and antioxidant mechanisms as well as through TGF -1β pathway.
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Ozturk Y, Bozkurt I, Yaman ME, Guvenc Y, Tolunay T, Bayram P, Hayirli N, Billur D, Erbay FK, Senturk S, Bozkurt G. Histopathologic Analysis of Tamoxifen on Epidural Fibrosis. World Neurosurg 2018; 111:e941-e948. [DOI: 10.1016/j.wneu.2018.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/31/2017] [Accepted: 01/04/2018] [Indexed: 12/14/2022]
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Wang S, Li X, Yan L, Chen H, Wang J, Sun Y. Upregulation of P27 Kip1 by mitomycin C induces fibroblast apoptosis and reduces epidural fibrosis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:11779-11788. [PMID: 31966541 PMCID: PMC6966039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/21/2017] [Indexed: 06/10/2023]
Abstract
Fibroblast excessive proliferation is considered as one of the major reasons of epidural fibrosis after laminectomy. Recent studies have shown that mitomycin C (MMC) could successfully reduce the formation of epidural fibrosis by inducing fibroblasts apoptosis. However, the detailed mechanism was still unclear. Increasing evidence indicated that P27Kip1 (P27) could result in apoptotic cell death in various cells. In this study, we investigated whether MMC could induce fibroblasts apoptosis and reduce epidural fibrosis by regulating P27. Western blot analysis, Hoechst staining, Flow cytometry, and Cell Counting Kit-8 (CCK-8) assay were used to detect the effect of MMC on fibroblasts apoptosis by regulating P27 expression in vitro. Moreover, histological and immunohistochemical assays were used to evaluate the effect of MMC on reducing epidural fibrosis by regulating P27 expression in rats. The results showed that MMC could induce fibroblasts apoptosis and upregulate P27 expression in vitro. Knockdown of P27 partially attenuated MMC-induced expressions of P27 and cleaved PARP as well as increased the cell viability. MMC could reduce epidural fibrosis in a dose-dependent manner in rats by histological analysis. The expression of P27 was increased by MMC treatment as shown by immuohistochemical analysis. In conclusion, this study demonstrated that MMC could upregulate P27 expression, which subsequently induced fibroblasts apoptosis and reduced epidural fibrosis.
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Affiliation(s)
- Shuguang Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
| | - Xiaolei Li
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
| | - Lianqi Yan
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
| | - Hui Chen
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
| | - Jingcheng Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
| | - Yu Sun
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
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Methotrexate prevents epidural fibrosis through endoplasmic reticulum stress signalling pathway. Eur J Pharmacol 2017; 796:131-138. [DOI: 10.1016/j.ejphar.2016.12.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/12/2016] [Accepted: 12/20/2016] [Indexed: 12/30/2022]
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Dai J, Sun Y, Yan L, Wang J, Li X, He J. Upregulation of NOXA by 10-Hydroxycamptothecin plays a key role in inducing fibroblasts apoptosis and reducing epidural fibrosis. PeerJ 2017; 5:e2858. [PMID: 28097065 PMCID: PMC5237371 DOI: 10.7717/peerj.2858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/03/2016] [Indexed: 12/16/2022] Open
Abstract
The fibrosis that develops following laminectomy or discectomy often causes serious complications, and the proliferation of fibroblasts is thought to be the major cause of epidural fibrosis. 10-Hydroxycamptothecin (HCPT) has been proven to be efficient in preventing epidural fibrosis, but the exact mechanism is still unclear. NOXA is a significant regulator of cell apoptosis, which has been reported to be beneficial in the treatment of fibrosis. We performed a series of experiments, both in vitro and in vivo, to explore the intrinsic mechanism of HCPT that underlies the induction of apoptosis in fibroblasts, and also to investigate whether HCPT has positive effects on epidural fibrosis following laminectomy in rats. Fibroblasts were cultured in vitro and stimulated by varying concentrations of HCPT (0, 1, 2, 4 µg/ml) for various durations (0, 24, 48, 72 h); the effect of HCPT in inducing the apoptosis of fibroblasts was investigated via Western blots and TUNEL assay. Our results showed that HCPT could induce apoptosis in fibroblasts and up-regulate the expression of NOXA. Following the knockdown of NOXA in fibroblasts, the results of Western blot analysis showed that the level of apoptotic markers, such as cleaved-PARP and Bax, was decreased. The results from the TUNEL assay also showed a decreased rate of apoptosis in NOXA-knocked down fibroblasts. For the in vivo studies, we performed a laminectomy at the L1-L2 levels in rats and applied HCPT of different concentrations (0.2, 0.1, 0.05 mg/ml and saline) locally; the macroscopic histological assessment, hydroxyproline content analysis and histological staining were performed to evaluate the effect of HCPT on reducing epidural fibrosis. The TUNEL assay in epidural tissues showed that HCPT could obviously induce apoptosis in fibroblasts in a dose-dependent manner. Also, immunohistochemical staining showed that the expression of NOXA increased as the concentrations of HCPT increased. Our findings are the first to demonstrate that upregulation of NOXA by HCPT plays a key role in inducing fibroblast apoptosis and in reducing epidural fibrosis. These findings might provide a potential therapeutic target for preventing epidural fibrosis following laminectomy.
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Affiliation(s)
- Jihang Dai
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| | - Yu Sun
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| | - Lianqi Yan
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| | - Jingcheng Wang
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| | - Xiaolei Li
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| | - Jun He
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
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Özay R, Yavuz OY, Aktaş A, Yiğit F, Çetinalp NE, Özdemir HM, Şekerci Z. Effects of cepae extract, allantoin, and heparin mixture on developing andalready formed epidural fibrosis in a rat laminectomy model. Turk J Med Sci 2016; 46:1233-9. [PMID: 27513430 DOI: 10.3906/sag-1504-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/13/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The study was designed to investigate whether local administration of a mixture composed of cepae extract, allantoin, and heparin (CAH) decreased already formed epidural fibrosis (EF) at the laminectomy site. MATERIALS AND METHODS Twenty-four adult male Sprague Dawley rats were equally divided into four groups. Laminectomy was performed at the L5 level in all rats. The group 2 and group 4 rats were treated with local drug administration. While the group 1 and 2 rats were sacrificed after 6 weeks, the remaining rats were reoperated and CAH mixture was applied in group 4. The vertebral columns of all rats were removed en bloc. Fibroblast numbers, EF, and arachnoidal involvement (AI) were evaluated. RESULTS The results of the treatment groups were separately compared with the control groups. The numbers of fibroblasts in the treatment groups were significantly lower than those in the control groups (P < 0.001). The grade of EF in group 2 was significantly less than that in group 1 (P < 0.05). There was no statistically significant difference regarding EF and AI grade between group 3 and group 4, and local application of the drug on EF and AI yielded better results than in the control groups. CONCLUSION The mixture composed of CAH might be a successful candidate for preventing EF in clinical practice.
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Affiliation(s)
- Rafet Özay
- T.C. Ministry of Health Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Osman Yüksel Yavuz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Turgut Özal University, Ankara, Turkey
| | - Abit Aktaş
- Department of Histology and Embryology, Faculty of Veterinary Medicine, İstanbul University, İstanbul, Turkey
| | - Funda Yiğit
- Department of Histology and Embryology, Faculty of Veterinary Medicine, İstanbul University, İstanbul, Turkey
| | - Nuri Eralp Çetinalp
- Department of Neurosurgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | | | - Zeki Şekerci
- T.C. Ministry of Health Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
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12
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Lin CY, Liu TY, Chen MH, Sun JS, Chen MH. An injectable extracellular matrix for the reconstruction of epidural fat and the prevention of epidural fibrosis. ACTA ACUST UNITED AC 2016; 11:035010. [PMID: 27271471 DOI: 10.1088/1748-6041/11/3/035010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Extensive epidural fibrosis is a common complication following spinal surgery and can cause pain and limited mobility. In the present study, a novel biomimetic approach was developed to prevent postsurgical adhesion of the dura. We aimed to reconstruct epidural fat, which prevents scar-tissue adhesion, through the development of an injectable decellularized adipose matrix (DAM)-containing hyaluronic acid (HA) hydrogel loaded with adipose stromal cells (ASCs). Injectable DAM was prepared from porcine adipose tissue by four freeze-thaw cycles with subsequent pepsin digestion. Residual analyses confirmed the efficacy of detergent-free decellularization, while most sulfated glycosaminoglycans and collagen were preserved. The Transwell migration assay demonstrated the anti-infiltrative property of the DAM-containing HA hydrogel. After 14 d of 3D culture, the DAM-containing HA hydrogel showed inductive potential in the adipogenic differentiation of ASCs. For an in vivo study, the ASC-loaded DAM-containing HA hydrogel (DAM/ASC-incorporated HA hydrogel) was injected into adult laminectomized male rats, and the results were assessed by microscopic histological examination. The in vivo data indicated that HA hydrogel, DAM, and ASCs were all required for the ability of the engineered fat tissue to block the invasion of the fibrous tissue. Our results suggested that this injectable DAM/ASC-incorporated HA hydrogel has potential applications in minimally invasive surgery for soft-tissue reconstruction and epidural fibrosis prevention.
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Affiliation(s)
- Cheng-Yi Lin
- Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
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Kizilay Z, Cetin NK, İsmailoglu Ö, Yılmaz A, Omurlu İK, Coskun ME, Aktaş S. The Effects of Rifampin, Povidone-Iodine and Hydrogen Peroxide on the Formation of Epidural Fibrosis in the Experimental Epidural Fibrosis Model. Inflammation 2016; 39:1495-502. [PMID: 27251380 DOI: 10.1007/s10753-016-0383-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of the study was to determine the effect of direct application of rifampin, povidone-iodine, and hydrogen peroxide on the formation of epidural fibrosis in rats. Forty-eight adult male Wistar albino rats were equally and randomly divided into four groups (laminectomy, topical rifampin, topical povidone-iodine, and topical hydrogen peroxide). Laminectomy was performed at the T12 level in all rats. Four weeks later, the extent of epidural fibrosis was assessed both macroscopically and histopathologically. ANOVA test was used for the evaluation of dural thickness. Kruskal-Wallis test was used for the pathology and macroscopic evaluation. Chi-square test was used for evaluation of the arachnoid involvement. p value <0.05 was accepted as statistically significant. Our data revealed that topical application of both povidone-iodine and hydrogen peroxide were effective in reducing epidural fibrosis formation. The results of our study provide the experimental evidence of the preventive effects of topical application of povidone-iodine and hydrogen peroxide over epidural fibrosis.
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Affiliation(s)
- Zahir Kizilay
- Faculty of Medicine, Adnan Menderes University, Aydin, Turkey.
| | | | | | - Ali Yılmaz
- Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | | | | | - Serdar Aktaş
- Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
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Sun Y, Zhao S, Li X, Yan L, Wang J, Wang D, Chen H, Dai J, He J. Local application of rapamycin reduces epidural fibrosis after laminectomy via inhibiting fibroblast proliferation and prompting apoptosis. J Orthop Surg Res 2016; 11:58. [PMID: 27154399 PMCID: PMC4859967 DOI: 10.1186/s13018-016-0391-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/17/2016] [Indexed: 12/20/2022] Open
Abstract
Background Epidural fibrosis is a common complication after laminectomy. It is associated with intractable lower back pain and additional complications. To date, no study has evaluated whether the local application of rapamycin (RAPA) can inhibit fibroblast proliferation and reduce epidural scar adhesion after laminectomy. The results of the present study showed that the local application of RAPA reduces epidural fibrosis after laminectomy in rats. Methods In this study, 32 male Sprague-Dawley rats were randomly divided into four groups (0.2 mg/ml RAPA-treated group, 0.1 mg/ml RAPA-treated group, 0.05 mg/ml RAPA-treated group and physiological saline group). Laminectomy was performed at the level of lumbar segment 1 to 2, and different concentrations of RAPA or saline were applied to the laminectomy sites for 10 min. Four weeks after laminectomy, the rats were sacrificed, and the degrees of epidural adhesion in each group were evaluated. Macroscopic assessment, analysis of hydroxyproline content, and histological analysis were used to determine the therapeutic effect of the local application of RAPA on the inhibition of fibroblast proliferation and the reduction of epidural fibrosis after laminectomy. Next, we cultured fibroblasts from epidural scar tissues of rats that had undergone laminectomy. Fibroblasts were exposed to the indicated concentrations of RAPA, and western blotting and TUNEL assays were used to assess the effects of RAPA on inhibiting fibroblasts proliferation and promoting fibroblast apoptosis. Results The results of macroscopic assessments, analysis of hydroxyproline content, and histological analyses indicated that RAPA significantly inhibited fibroblast proliferation and reduced epidural fibrosis in the treated groups in the rat model. The western blotting results indicated that the expression levels of the pro-apoptotic proteins cleaved-PARP and Bax were up-regulated, whereas those of Bcl-2 were reduced. TUNEL assay indicated that the apoptosis rates of fibroblasts were significantly increased after exposure to the indicated concentrations of RAPA. Conclusions The local application of RAPA reduced epidural fibrosis after laminectomy by inhibiting the proliferation of fibroblasts, stimulating their apoptosis, and decreasing collagen synthesis. This protocol may be used in new clinical treatment strategies to reduce epidural fibrosis after laminectomy.
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Affiliation(s)
- Yu Sun
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Shuai Zhao
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha, Hunan, 410012, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Xiaolei Li
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha, Hunan, 410012, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Lianqi Yan
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China. .,Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha, Hunan, 410012, China. .,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China.
| | - Jingcheng Wang
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China. .,Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha, Hunan, 410012, China. .,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China.
| | - Daxin Wang
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Hui Chen
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Jihang Dai
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
| | - Jun He
- Department of Orthopedics, Clinical medical college of Yangzhou University, Nantong West Road 98, Yangzhou, Jiangsu, 225001, China.,Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, China
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Interrater Reliability of the Postoperative Epidural Fibrosis Classification: A Histopathologic Study in the Rat Model. Asian Spine J 2015; 9:587-94. [PMID: 26240719 PMCID: PMC4522450 DOI: 10.4184/asj.2015.9.4.587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/30/2015] [Accepted: 02/11/2015] [Indexed: 11/29/2022] Open
Abstract
Study Design Agreement study. Purpose To validate the interrater reliability of the histopathological classification of the post-laminectomy epidural fibrosis in an animal model. Overview of Literature Epidural fibrosis is a common cause of failed back surgery syndrome. Many animal experiments have been developed to investigate the prevention of epidural fibrosis. One of the common outcome measurements is the epidural fibrous adherence grading, but the classification has not yet been validated. Methods Five identical sets of histopathological digital files of L5-L6 laminectomized adult Sprague-Dawley rats, representing various degrees of postoperative epidural fibrous adherence were randomized and evaluated by five independent assessors masked to the study processes. Epidural fibrosis was rated as grade 0 (no fibrosis), grade 1 (thin fibrous band), grade 2 (continuous fibrous adherence for less than two-thirds of the laminectomy area), or grade 3 (large fibrotic tissue for more than two-thirds of the laminectomy area). A statistical analysis was performed. Results Four hundred slides were independently evaluated by each assessor. The percent agreement and intraclass correlation coefficient (ICC) between each pair of assessors varied from 73.5% to 81.3% and from 0.81 to 0.86, respectively. The overall ICC was 0.83 (95% confidence interval, 0.81-0.86). Conclusions The postoperative epidural fibrosis classification showed almost perfect agreement among the assessors. This classification can be used in research involving the histopathology of postoperative epidural fibrosis; for example, for the development of preventions of postoperative epidural fibrosis or treatment in an animal model.
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Sui T, Zhang J, Du S, Su C, Que J, Cao X. Potential risk of mitomycin C at high concentrations on peripheral nerve structure. Neural Regen Res 2014; 9:821-7. [PMID: 25206895 PMCID: PMC4146259 DOI: 10.4103/1673-5374.131598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 11/04/2022] Open
Abstract
Although the local application of mitomycin C may prevent epidural adhesion after laminectomy, mitomycin C can induce neurotoxicity in optic and acoustic nerves at high concentrations. To determine the safe concentration range for mitomycin C, cotton pads soaked with mitomycin C at different concentrations (0.1, 0.3, 0.5, and 0.7 mg/mL) were immediately applied for 5 minutes to the operation area of rats that had undergone laminectomy at L1. Rat sciatic nerves, instead of dorsal nerves, were used in this study. The results showed that mitomycin C at 0.1-0.5 mg/mL did not damage the structure and function of the sciatic nerve, while at 0.7 mg/mL, mitomycin C significantly reduced the thickness of the sciatic nerve myelin sheath compared with lower concentrations, though no functional change was found. These experimental findings indicate that the local application of mitomycin C at low concentrations is safe to prevent scar adhesion following laminectomy, but that mitomycin C at high concentrations (> 0.7 mg/mL) has potential safety risks to peripheral nerve structures.
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Affiliation(s)
- Tao Sui
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jinhong Zhang
- Department of Orthopedics, the Second Hospital of Nanjing, Affiliated to Southeast University, Nanjing, Jiangsu Province, China
| | - Shihao Du
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Changhui Su
- Department of Orthopedics, Affiliated Hospital of Taishan Medical College, Taishan, Shandong Province, China
| | - Jun Que
- Department of Intensive Care Unit, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiaojian Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Zhang C, Kong X, Ning G, Liang Z, Qu T, Chen F, Cao D, Wang T, Sharma HS, Feng S. All-trans retinoic acid prevents epidural fibrosis through NF-κB signaling pathway in post-laminectomy rats. Neuropharmacology 2013; 79:275-81. [PMID: 24316159 DOI: 10.1016/j.neuropharm.2013.11.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/06/2013] [Accepted: 11/18/2013] [Indexed: 01/02/2023]
Abstract
Laminectomy is a widely accepted treatment for lumbar disorders, and epidural fibrosis (EF) is a common complication. EF is thought to cause post-operative pain recurrence after laminectomy or discectomy. All-trans retinoic acid (ATRA) has shown anti-fibrotic, anti-inflammatory, and anti-proliferative functions. The object of this study was to investigate the effects of ATRA on the prevention of EF in post-laminectomy rats. In vitro, the anti-fibrotic effect of ATRA was demonstrated with cultured fibroblasts count, which comprised of those that were cultured with/without ATRA. In vivo, rats underwent laminectomy at the L1-L2 levels. We first demonstrated the beneficial effects using 0.05% ATRA compared to vehicle (control group). We found that a higher concentration of ATRA (0.1%) achieved dose-dependent results. Hydroxyproline content, Rydell score, vimentin-positive cell density, fibroblast density, inflammatory cell density and inflammatory factor expression levels all suggested better outcomes in the 0.1% ATRA rats compared to the other three groups. Presumably, these effects involved ATRA's ability to suppress transforming growth factor (TGF-β1) and interleukin (IL)-6 which was confirmed with reverse-transcriptase polymerase chain reaction (RT-PCR). Finally we demonstrated that ATRA down-regulated nuclear factor (NF)-κB by immunohistochemistry and western blotting for p65 and inhibition of κB (IκBα), respectively. Our findings indicate that topical application of ATRA can inhibit fibroblast proliferation, decrease TGF-β1 and IL-6 expression level, and prevent epidural scar adhesion in rats. The highest concentration employed in this study (0.1%) was the most effective. ATRA suppressed EF through down-regulating NF-κB signaling, whose specific mechanism is suppression of IκB phosphorylation and proteolytic degradation.
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Affiliation(s)
- Chao Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xiaohong Kong
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Guangzhi Ning
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zhipin Liang
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Tongjun Qu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Feiran Chen
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Daigui Cao
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Tianyi Wang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hari S Sharma
- Laboratory of Cerebrovascular Research, Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, University Hospital, Uppsala University, Frödingsgatan 12, 75421 Uppsala, Sweden
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China.
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Affiliation(s)
- Mijin Kim
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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An Experimental Novel Study: Angelica sinensis Prevents Epidural Fibrosis in Laminectomy Rats via Downregulation of Hydroxyproline, IL-6, and TGF- β 1. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:291814. [PMID: 24069047 PMCID: PMC3773456 DOI: 10.1155/2013/291814] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 07/22/2013] [Accepted: 07/31/2013] [Indexed: 12/13/2022]
Abstract
With laminectomy being widely accepted as the treatment for lumbar disorders, epidural fibrosis (EF) is a common complication for both the patients and the surgeons alike. Currently, EF is thought to cause recurrent postoperative pain after laminectomy or after discectomy. Angelica sinensis is a traditional Chinese medicine which has shown anti-inflammatory, antifibrotic, and antiproliferative properties. The object of this study was to investigate the effects of Angelica sinensis on the prevention of post-laminectomy EF formation in a rat model. A controlled double-blinded study was conducted in sixty healthy adult Wistar rats that underwent laminectomy at the L1-L2 levels. They were divided randomly into 3 groups according to the treatment method, with 20 in each group: (1) Angelica sinensis treatment group, (2) saline treatment group, and (3) sham group (laminectomy without treatment). All rats were euthanized humanely 4 weeks after laminectomy. The hydroxyproline content, Rydell score, vimentin cells density, fibroblasts density, inflammatory cells density, and inflammatory factors expressions all suggested better results in Angelica sinensis group than the other two groups. Topical application of Angelica sinensis could inhibit fibroblasts proliferation and TGF-β1 and IL-6 expressions and prevent epidural scar adhesion in postlaminectomy rat model.
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Liu L, Sui T, Hong X, Wu X, Cao X. Inhibition of epidural fibrosis after microendoscopic discectomy with topical application of mitomycin C: a randomized, controlled, double-blind trial. J Neurosurg Spine 2013; 18:421-7. [PMID: 23473374 DOI: 10.3171/2013.1.spine12564] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors conducted a study to evaluate the effects and the safety of locally applied mitomycin C (MMC) on epidural fibrosis after microendoscopic discectomy (MED). METHODS Seventy-five patients undergoing single-level unilateral MED for lumbar disc herniation were randomly assigned to receive cotton wool impregnated with either 0.5 mg/ml MMC or saline applied at the site of discectomy for 5 minutes. Outcome measures included degrees of pain severity, functional disability, physical symptoms, and quantitative evaluation of postoperative epidural fibrosis shown on follow-up lumbar contrast-enhanced MRI. RESULTS Sixty-two patients completed the follow-up. Neither serious drug adverse effects nor clinically significant laboratory adverse effects were observed. Patients in both groups showed similar clinical recoveries postoperatively. A statistically significant difference (p < 0.05) between the 2 treatments was shown in a quantitative evaluation of postoperative MRI-documented epidural fibrosis in the MMC group and the saline group using a modified grading system. The mean cross-sectional areas of epidural fibrosis were 7.32-70.06 mm(2) in the MMC group and 22.94-90.48 mm(2) in the saline group. The epidural fibrosis index ranged from 0.0296 to 0.3267 in the MMC group and from 0.1191 to 0.3483 in the saline group. A significant difference was also observed using the Ross grading system to evaluate postoperative MR images. CONCLUSIONS Although no benefit was observed clinically, the authors observed a notable reduction of epidural fibrosis after MED radiologically, with 0.5 mg/ml MMC locally applied and no clinical side effects.
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Affiliation(s)
- Lei Liu
- Department of Orthopedics, Affiliated ZhongDa Hospital of Southeast University, Nanjing, China
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Kaya M, Yildirim CH, Kosemehmetoglu K, Huseyinoglu U, Erdogan H, Akbasak A, Tasdemiroglu E. Alpha-lipoic acid reduces peridural fibrosis after laminectomy of lumbar vertebrae in rabbits. Acta Neurochir (Wien) 2012; 154:1241-5. [PMID: 22610532 DOI: 10.1007/s00701-012-1382-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 05/02/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Peridural fibrosis is an inevitable healing process causing failed back surgery syndrome after lumbar spinal operations. In this study, alpha-lipoic acid (ALA), reported to reduce fibrosis in liver, oral mucosa, and peritoneum, investigated as a potential candidate for prevention of peridural fibrosis. METHOD Twelve adult New Zealand white male rabbits were divided into control (n = 5) and ALA groups (n = 7). Laminectomy of lumbar spine was performed and ALA was applied on the exposed dura mater topically in ALA group. RESULTS According to histological peridural grading, the ALA group (median grade 1) showed significantly less peridural fibrosis than the control group (median grade 3, p = 0.005). CONCLUSIONS ALA is a promising substance in the prevention of peridural fibrosis, especially in early preoperative and postoperative period.
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Effect of topical application of mitomycin-C on wound healing in a postlaminectomy rat model: an experimental study. Eur J Pharmacol 2011; 674:7-12. [PMID: 22056834 DOI: 10.1016/j.ejphar.2011.10.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 10/04/2011] [Accepted: 10/11/2011] [Indexed: 11/22/2022]
Abstract
The aim of this study was to investigate the effects of topical application mitomycin-C (MMC) on wound healing after laminectomy. 60 adult male SD rats were equally and randomly divided into five groups. Laminectomy was performed at the level of L1 in all rats. After hemostasis was achieved, cotton pads soaked with saline and MMC (0.1mg/ml, 0.3mg/ml, 0.5mg/ml and 0.7mg/ml) were directly subjected to the exposed dura for 5min in each group. Two weeks after laminectomy all the rats were killed. The vertebral column including the back scar tissue and muscles was obtained to make paraffin sections. The hematoxylin-eosin staining and Masson staining were performed with the obtained paraffin sections. The number of the fibroblast and the capillary density were counted by the hematoxylin-eosin staining slice. The extent of epidural fibrosis and the expression of vascular endothelial growth factor (VEGF) were evaluated by the immunohistochemical slice through a computer image analysis system. Our data showed that the number of fibroblast, capillary density and fibrotic tissue in the 0.5 and 0.7mg/ml MMC groups was significantly lower than the control, 0.1 and 0.3mg/ml MMC groups; while the expression of VEGF in control and 0.1mg/ml MMC groups was notably higher than 0.3, 0.5 and 0.7mg/ml MMC groups. Topical application of MMC above the concentration of 0.3mg/ml could affect all steps of the wound healing process via inhibiting the angiogenesis and fibroblast proliferation, thus delayed the wound healing after laminectomy.
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Choi HJ, Kim KB, Kwon YM. Effect of amniotic membrane to reduce postlaminectomy epidural adhesion on a rat model. J Korean Neurosurg Soc 2011; 49:323-8. [PMID: 21887388 DOI: 10.3340/jkns.2011.49.6.323] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 03/30/2011] [Accepted: 05/30/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Epidural fibrosis and adhesion are the main reasons for post-laminectomy sustained pain and functional disability. In this study, the authors investigate the effect of irradiated freeze-dried human amniotic membrane on reducing epidural adhesion after laminectomy on a rat model. METHODS A total of 20 rats were divided into two groups. The group A did not receive human amniotic membrane implantation after laminectomy and group B underwent human amniotic membrane implantation after laminectomy. Gross and microscopic findings were evaluated and compared at postoperative 1, 3 and 8 weeks. RESULTS The amount of scar tissue and tenacity were reduced grossly in group of rats with human amniotic membrane implantation (group B). On a microscopic evaluation, there were less inflammatory cell infiltration and fibroblast proliferation in group B. CONCLUSION This experimental study shows that implantation of irradiated freeze-dried human amniotic membrane reduce epidural fibrosis and adhesion after spinal laminectomy in a rat model.
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Affiliation(s)
- Hyu Jin Choi
- Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
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Postlaminectomy osteopontin expression and associated neurophysiological findings in rat peridural scar model. Spine (Phila Pa 1976) 2011; 36:378-85. [PMID: 20838370 DOI: 10.1097/brs.0b013e3181d12ef4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Su C, Yao C, Lu S, Zhang A, Cao X, Teng G, Zang F. Study on the optimal concentration of topical mitomycin-C in preventing postlaminectomy epidural adhesion. Eur J Pharmacol 2010; 640:63-7. [PMID: 20450905 DOI: 10.1016/j.ejphar.2010.04.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 04/01/2010] [Accepted: 04/23/2010] [Indexed: 11/18/2022]
Abstract
There is increasing evidence that topical application of mitomycin-C can be beneficial in reducing epidural scar adhesion. However, the ideal concentration of mitomycin-C is unknown. The purpose of this study was to verify its efficacy for preventing epidural adhesion and the immediate electrophysiological responses caused by it in a laminectomy model. Seventy rats underwent laminectomy at L-1 and L-2. Cotton pads soaked with saline and various concentrations of mitomycin-C (0.1 mg/ml, 0.3 mg/ml, 0.5 mg/ml and 0.7 mg/ml) were applied to the exposed dura for 5 min. Spine somatosensory evoked potentials (SSEP) were monitored in preoperative and the immediate electrophysiological responses of mitomycin-C used. Four weeks postlaminectomy the rats were killed. The area of epidural scar tissue and degree of epidural adhesion were determined by 7.0 T Micro MR imaging. Macroscopic evaluations were performed according to the Rydell standard. The results showed that severe epidural adhesion was formed in the saline group and no dural adherence or incomplete adhesions were found in the mitomycin-C group. The Rydell classification and the degree of epidural adhesion and the area of the scar in 0.5 mg/ml group and 0.7 mg/ml mitomycin-C group revealed a significant decrease compared with the control group and 0.1 mg/ml group and 0.3 mg/ml mitomycin-C group. The spine sensory evoked potentials did not alter obviously in both preoperative and the immediate electrophysiological responses of mitomycin-C used. In conclusion, locally applied mitomycin-C in a concentration of 0.5 mg/ml and 0.7 mg/ml mitomycin-C may be the optimal concentration in preventing postlaminectomy epidural adhesion.
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Affiliation(s)
- Changhui Su
- Department of Orthopedics Surgery, the First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu Province, China
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Cemil B, Tun K, Kaptanoglu E, Kaymaz F, Cevirgen B, Comert A, Tekdemir I. Use of pimecrolimus to prevent epidural fibrosis in a postlaminectomy rat model. J Neurosurg Spine 2010; 11:758-63. [PMID: 19951030 DOI: 10.3171/2009.6.spine08580] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Epidural fibrosis is the scar tissue formed over the dura mater after a laminectomy. Extensive epidural fibrosis may be an important underlying cause of failed back syndrome. Pimecrolimus, an ascomycin derivative, is one of the new classes of immunomodulating macrolactams and was specifically developed for the treatment of inflammatory diseases. This study examined the preventive effects of the local application of pimecrolimus in minimizing spinal epidural fibrosis in a rat laminectomy model. METHODS Thirty Wistar rats were divided into 3 equal groups: control, mitomycin C (MMC), and pimecrolimus groups. Each rat underwent a laminectomy at the L-3 lumbar level. In the experimental groups, a cotton pad soaked with MMC (0.5 mg/ml) or 5 mg pimecrolimus was placed on the exposed dura mater. No treatment was performed in the control group rats. Thirty days after surgery, the rats were killed and the dura mater thickness, epidural fibrosis, and arachnoidal involvement were quantified. RESULTS The mean dura thickness was measured at 9.28 +/- 3.39 microm in the MMC group and at 8.69 +/- 2.32 microm in the pimecrolimus group, compared with 14.70 +/- 4.14 microm in the control group. In addition, the epidural fibrosis and arachnoidal involvement were reduced significantly in the treatment groups compared with the control group. CONCLUSIONS In this animal model, it was shown that locally applied pimecrolimus effectively reduces epidural fibrosis and dural adherence in rats that underwent lumbar laminectomy. Mitomycin C was equally effective as pimecrolimus in reducing epidural fibrosis and dural adherence in this study.
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Affiliation(s)
- Berker Cemil
- Department of Neurosurgery, Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Çelik SE, Altan T, Çelik S, Göksu K, İnce İ, Kapran Z. Mitomycin protection of peridural fibrosis in lumbar disc surgery. J Neurosurg Spine 2008; 9:243-8. [DOI: 10.3171/spi/2008/9/9/243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this prospective, randomized clinical study the authors sought to evaluate the effects of locally applied mitomycin C on peridural fibrosis during lumbar microdiscectomy.
Methods
Patients undergoing lumbar disc surgery were randomly divided into 2 groups. Thirty patients had 1 mg/ml mitomycin C applied at the site of discectomy for 5 minutes, and 30 age- and sex-matched patients underwent lumbar microdiscectomy without mitomycin C application as the control group. The groups were compared for degree of postoperative neurological function, radicular/back pain, and degree of peridural fibrosis on MR imaging 6 months after the operation.
Results
The median follow-up was 18 months. No serious drug adverse effects and no clinically significant laboratory adverse effects were reported in patients in the mitomycin C group. Patients in both groups showed similar clinical recoveries postoperatively. On postoperative evaluation of the MR images, pain scores, and neurological function, patients given mitomycin C have shown no reduction of peridural fibrosis either clinically or radiographically.
Conclusions
Mitomycin C is easy to use and safe in patients undergoing lumbar microdiscectomy. However, no benefit was observed either clinically or radiographically in this study.
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Affiliation(s)
| | - Tugrul. Altan
- 2Second Ophthalmology Clinic, Beyoglu Eye Research and Training Hospital
| | - Sevinç Çelik
- 3Department of Neurology, Okmeydani Research and Training Hospital; and
| | - Kamber Göksu
- 4Department of Radiology, Centermed Neuroradiology Center, Istanbul, Turkey
| | - İrfan İnce
- 4Department of Radiology, Centermed Neuroradiology Center, Istanbul, Turkey
| | - Ziya Kapran
- 2Second Ophthalmology Clinic, Beyoglu Eye Research and Training Hospital
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