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Simsek EK, Sahinturk F, Gul E, Tepeoglu M, Araz C, Haberal B. Effect of Ozone Therapy on Epidural Fibrosis in Rats. World Neurosurg 2023; 175:e296-e302. [PMID: 36965663 DOI: 10.1016/j.wneu.2023.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To demonstrate the effect of medical ozone therapy on the development of epidural fibrosis. METHODS A total of 25 Sprague-Dawley male rats were randomly divided into 3 groups: a control group (L3-L4 laminectomy only), a systemic ozone therapy (SOT) group (L3-L4 laminectomy only + intraperitoneal 15 mL [30 μg/mL] ozone), and a local ozone therapy (LOT) group (L3-L4 laminectomy only + subcutaneous 15 mL [30 μg/mL] ozone). Ozone therapy was administered 4 times on a 3-day interval during the wound-healing process, with the first dose immediately administered after surgery. The effects of ozone therapy on vascular endothelial growth factor, inflammation, and epidural fibrosis between groups were evaluated. RESULTS Staining with vascular endothelial growth factor was significantly less in the group that received SOT compared with the control group (P = 0.021). When the groups were compared in terms of inflammation, it was found that inflammation was less common in the SOT and LOT groups compared with the control group (SOT vs. control: P = 0.004 and LOT vs. control: P = 0.024), whereas inflammation was found to be significantly less in the SOT group compared with the LOT group (P = 0.008). In the histopathologic evaluation of epidural fibrosis, there was no significant difference between the SOT and LOT groups but less epidural fibrosis was observed in both groups compared to the control group (LOT vs. control: P = 0.037; SOT vs. control: P = 0.018). CONCLUSIONS Medical ozone therapy may be an alternative method that can be used effectively and safely in the prevention of epidural fibrosis after laminectomy.
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Affiliation(s)
- Ekin Kaya Simsek
- Department of Orthopaedic and Traumatology, Baskent University Hospital, Ankara, Turkey
| | - Fikret Sahinturk
- Department of Neurosurgery, Baskent University Hospital, Ankara, Turkey
| | - Eylem Gul
- Department of Biostatistics, Baskent University Hospital, Ankara, Turkey
| | - Merih Tepeoglu
- Department of Pathology, Baskent University Hospital, Ankara, Turkey
| | - Coskun Araz
- Department of Anesthesiology, Baskent University Hospital, Ankara, Turkey
| | - Bahtiyar Haberal
- Department of Orthopaedic and Traumatology, Baskent University Hospital, Ankara, Turkey.
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Masopust V, Holubová J, Skalický P, Rokyta R, Fricová J, Lacman J, Netuka D, Patríková J, Janoušková K. Neuromodulation in the treatment of postoperative epidural fibrosis: comparison of the extent of epidural fibrosis and the effect of stimulation. Physiol Res 2021; 70:461-468. [PMID: 33982586 DOI: 10.33549/physiolres.934617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The goal was to prove that when a cohort of patients is chosen precisely, dorsal column stimulation provides significant improvement to quality of life. We studied a cohort of 50 patients with the history of failed back surgery syndrome coupled with epidural fibrosis (EF). A percutaneous implantation technique was used in each of the 50 patients. The study group was composed of 20 women and 28 men aged 26-67 years (mean age 49). A prospective observational questionnaire-based study was used. According to the methods, Ross's classification was adjusted to four degrees of scar size for our study objective. Despite this adjustment, it was not possible to statistically evaluate our research, due to very similar results in Groups I, III and IV. Patients without epidural fibrosis were assigned to Group 0, and patients with EF of different ranges were assigned to Group 1. The mean change in visual analogue scale DeltaVAS after our division into Group 0 was 4.82; for Group 1 it was 6.13. Evaluation of EF and DeltaVAS correlation by paired t-test shows a statistically higher effect of spinal cord stimulation (SCS) in the epidural fibrosis group, compared to group 0 without postoperative epidural fibrosis (p=0.008). The extent of epidural fibrosis is an important factor for Failed back surgery syndrome (FBSS). FBSS is the basis for the existence of neuropathic pain after lumbar spinal surgery. There is clear evidence of a correlation between patients with epidural scar formation on MR scan and the effect of dorsal column stimulation.
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Affiliation(s)
- V Masopust
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague 6, Czech Republic.
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Impact of radial extracorporeal shock wave therapy in post-laminectomy epidural fibrosis in a rat model. Jt Dis Relat Surg 2021; 32:162-169. [PMID: 33463432 PMCID: PMC8073443 DOI: 10.5606/ehc.2021.77870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to investigate the effect of radial extracorporeal shock wave therapy (rESWT) treatment in the prevention of epidural fibrosis after laminectomy in rats. Materials and methods
Eighteen 16-month-old male Sprague-Dawley rats weighing 300 g were used in this experimental study between November 2019 and February 2020. The rats were randomly divided into two groups as the control group (L3-L4 total laminectomy without any treatment) and the study group (L3-L4 total laminectomy plus rESWT). The rats were sacrificed at the postoperative sixth week and the lumbar spine was excised en bloc, fixed, and decalcified. Sections were stained with hematoxylin-eosin to evaluate epidural fibrosis, acute inflammation, chronic inflammation, and vascular proliferation. Results
The median value and standard deviations were obtained based on histological examinations. Accordingly, epidural fibrosis decreased significantly in the study group compared to the control group. There was no statistically significant difference between the groups in terms of acute and chronic inflammation response and vascular proliferation. Conclusion
The rESWT application immediately after surgery is effective in preventing epidural fibrosis after laminectomy in rats.
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Effect of topical rifamycin application on epidural fibrosis in rats. Turk J Phys Med Rehabil 2019; 65:24-29. [PMID: 31453541 DOI: 10.5606/tftrd.2019.2442] [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: 12/01/2017] [Accepted: 02/01/2018] [Indexed: 10/27/2022] Open
Abstract
Objectives This study aims to investigate the effects of topical rifamycin SV application on epidural fibrosis formation in a rat model. Materials and methods Between March 2015 and April 2015, a total of 20 Wistar rats were equally and randomly divided into laminectomy only group (control group) and laminectomy and rifamycin SV group (treatment group). Laminectomy was performed between L3-L5 in all rats. Surgical field was irrigated with 1 mL rifamycin SV (1 mL). After four weeks, vertebral columns of the rats were removed en bloc between the L1 and L5 levels, and epidural fibrosis and arachnoid involvement were histopathologically evaluated and graded. Results Grade 3 epidural fibrosis formation ratio was lower in the treatment group (40%) compared to the control group (80%). However, there was no statistically significant difference between the treatment and control groups in terms of epidural fibrosis (p=0.164) and arachnoid involvement (p=0.303). Conclusion Intraoperative rifamycin irrigation tends to reduce epidural fibrosis formation risk, although not statistically significant.
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Demirel E, Yildiz K, Çadirci K, Aygün H, Şenocak E, Gündoğdu B. Effect of platelet-rich fibrin on epidural fibrosis and comparison to ADCON® Gel and hyaluronic acid. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:469-474. [PMID: 30217689 PMCID: PMC6318501 DOI: 10.1016/j.aott.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 04/21/2018] [Accepted: 07/27/2018] [Indexed: 12/20/2022]
Abstract
Objective In this experimental study, PRF (Platelet Rich Fibrin), HA (Hyaluronic Acid) gel and ADCON® Gel were compared in terms of preventing epidural fibrosis. Methods Twenty-eight Sprague–Dawley rats (mean weight, 400–450 g) were divided into 4 groups. L3-L4 laminectomy was performed in each group. Following laminectomy, Adcon® Gel, HA gel and PRF were applied onto the surgery site locally in Group 1, 2 and 3, respectively. Group 4 was maintained as control without any local application. After five weeks, L3-L4 vertebrae were removed totally and taken to histopathological evaluation for epidural fibrosis, acute inflammatory cell density, chronic inflammatory cell density, hemorrhage, angiogenesis and new bone formation. Results Acute inflammation cell density, angiogenesis, and new bone formation levels were comparable among the study groups (p > 0.05). However, new bone formation was higher in the PRF group. Epidural fibrosis and chronic inflammatory cell density were significantly lower in the PRF group (p < 0.05). Conclusion We concluded that PRF contributed to hemostasis and prevented epidural fibrosis.
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Hart R. Topping Phenomenon with Recurrent Spinal Stenosis and Epidural Fibrosis Prevented with Oxidized Cellulose - a Case Report. ACTA MEDICA (HRADEC KRÁLOVÉ) 2018; 61:69-73. [PMID: 30216187 DOI: 10.14712/18059694.2018.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Lumbar spinal stenosis is a condition where the neural structures are compressed in the narrowed spinal canal and often situated only within a single specific segment of the spine, most frequently in the lumbar spine. A case report demonstrates a surgical solution of lumbar spinal stenosis with using oxidized cellulose as a prevention of post-operative adhesions and failed back syndrome. A female patient (68) with a significant pain of the lumbar spine lasting for a number of months due to advanced spondylosis, failing to respond to conservative treatment underwent instrumented, posterolateral fusion of affected segments. The patient re-arrived with pain due to spinal stenosis in another segments after 4 and then after 3 years. We repeatedly performed spinal fusion of the affected segments and applied an antiadhesive gel to the dural sac and the decompressed nerve roots to prevent the development of post-operative adhesions and the "failed back syndrome". Last surgical solution included mobilisation of the simultaneously constricted dural sac through laminectomy. This time we covered the sac using a haemostat made of oxidized cellulose (Traumacel FAM). After this treatment, the patient was again without significant difficulties.
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Affiliation(s)
- Radek Hart
- Department of Orthopaedics and Traumatology, General Hospital Znojmo, Czech Republic.
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Xie H, Wang B, Shen X, Qin J, Jiang L, Yu C, Geng D, Yuan T, Wu T, Cao X, Liu J. MMC controlled-release membranes attenuate epidural scar formation in rat models after laminectomy. Mol Med Rep 2017; 15:4162-4168. [PMID: 28487972 PMCID: PMC5436155 DOI: 10.3892/mmr.2017.6531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/27/2017] [Indexed: 11/28/2022] Open
Abstract
Epidural scar formation after laminectomy impede surgical outcomes of decompression. Mitomycin C (MMC) has been demonstrated to have significant inhibitory effects on epidural scar. This study was undertaken to develop an effective MMC controlled-release membrane and to investigate its effects on epidural scar in rat models of laminectomy. A total of 72 rats that underwent laminectomy were divided into three groups. Among them, 24 were treated with mitomycin C-polylactic acid (MMC-PLA) controlled-release membrane, 24 with mitomycin C-polyethylene glycol (MMC-PEG) controlled-release membrane, and no treatment was performed for the remaining 24 rats (control group). In the following 4 weeks, magnetic resonance image (MRI), macroscopic observation, histology and hydroxyproline (Hyp) concentration analysis were performed to explore the effects of these three therapies on epidural scar. MRI revealed a significant reduction of epidural fibrosis in MMC-PLA and MMC-PEG treatment groups, compared with the control group. Histological results also showed that collagen deposition was significantly reduced after being treated with MMC-PLA or MMC-PEG membranes. Likewise, Hyp concentrations of the epidural scar tissue in MMC-PLA and MMC-PEG groups were markedly lower than those in the control group. However, regarding the effects on reducing epidural scar, no significant difference was found between the MMC-PLA and MMC-PEG groups. In conclusion, MMC-PLA and MMC-PEG membranes are safe and effective in reducing fibrosis. Thus, MMC-controlled-release membranes promises to be a potential therapeutic in preventing epidural scar formation after laminectomy.
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Affiliation(s)
- Hao Xie
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Binbin Wang
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Xun Shen
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Jian Qin
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Longhai Jiang
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Chen Yu
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Dawei Geng
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Tangbo Yuan
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Tao Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Xiaojian Cao
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Jun Liu
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
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Park JW, Bak KH, Cho TK, Chun HJ, Ryu JI. Effects of a Temperature-Sensitive, Anti-Adhesive Agent on the Reduction of Adhesion in a Rabbit Laminectomy Model. J Korean Neurosurg Soc 2016; 59:250-8. [PMID: 27226857 PMCID: PMC4877548 DOI: 10.3340/jkns.2016.59.3.250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 09/04/2015] [Accepted: 12/21/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE A common cause of failure in laminectomy surgery is when epidural, peridural, or perineural adhesion occurs postoperatively. The purpose of this study is to examine the efficacy of a temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG®, as a mechanical barrier for the prevention or reduction of peridural scar adhesion in a rabbit laminectomy model. METHODS Twenty-six mature rabbits were used for this study. Each rabbit underwent two separate laminectomies at lumbar vertebrae L3 and L6, left empty (the control group) and applied 2 mL of the TSAA agent (the experimental group), respectively. Invasive scar formation or inflammation after laminectomy was quantitatively evaluated by measuring the thickness of the dura, the distance from the surface of dura to the scar tissues, the number of inflammatory cells in the scar tissues at the laminectomy site, and the concentration of collagen in histological sections. RESULTS At 6 weeks postsurgery, the dura was significantly thinner and the distance from the surface of dura to the scar tissues was greater in the experimental group than in the control group (p=0.04 and p=0.01). The number of inflammatory cells was not significantly different in the two groups (p=0.08), although the mean number of inflammatory cells was relatively lower in the experimental group than in the control group. CONCLUSION The current study suggests that the TSAA agent, Guardix-SG®, could be useful as an interpositional physical barrier after laminectomy for the prevention or reduction of adhesion.
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Affiliation(s)
- Jeong Woo Park
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Koang Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Tae Koo Cho
- Department of Neurosurgery, The Bone Spine & Joint Hospital Spine Center, Seoul, Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
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Gürer B, Kahveci R, Gökçe EC, Ozevren H, Turkoglu E, Gökçe A. Evaluation of topical application and systemic administration of rosuvastatin in preventing epidural fibrosis in rats. Spine J 2015; 15:522-9. [PMID: 25452015 DOI: 10.1016/j.spinee.2014.10.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 09/23/2014] [Accepted: 10/19/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Epidural fibrosis is a major challenge in spine surgery, with some patients having recurrent symptoms secondary to excessive formation of scar tissue resulting in neurologic compression. One of the most important factors initiating the epidural fibrosis is assumed to be the transforming growth factor-1β (TGF-1β). Rosuvastatin (ROS) has shown to demonstrate preventive effects over fibrosis via inhibiting the TGF-1β. PURPOSE We hypothesized that ROS might have preventive effects over epidural fibrosis through the inhibition of TGF-1β pathways. STUDY DESIGN Experimental animal study. METHODS Forty-eight adult male Wistar Albino rats were equally and randomly divided into four groups (laminectomy, spongostan, topical ROS, and systemic ROS). Laminectomy was performed at the L3 level in all rats. Four weeks later, the extent of epidural fibrosis was assessed both macroscopically and histopathologically. RESULTS Our data revealed that topical application and systemic administration of ROS both were effective in reducing epidural fibrosis formation. Furthermore, the systemic administration of ROS yielded better results than topical application. CONCLUSIONS Both topical application and systemic administration of ROS show meaningful preventive effects over epidural fibrosis through multiple mechanisms. The results of our study provide the first experimental evidence of the preventive effects of ROS over epidural fibrosis.
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Affiliation(s)
- Bora Gürer
- Department of Neurosurgery, Ministry of Health, Fatih Sultan Mehmet Education and Research Hospital, 34752, Ataşehir, Istanbul, Turkey.
| | - Ramazan Kahveci
- Department of Neurosurgery, Ministry of Health, Kirikkale Yüksek Ihtisas Hospital, Baglarbasi mh. Lokman Hekim cd., Kirikkale, Turkey
| | - Emre Cemal Gökçe
- Department of Neurosurgery, Faculty of Medicine, Turgut Ozal University, Ayvali mh., Gazze cd., No:7 Etlik, Kecioren, Ankara, Turkey
| | - Huseyin Ozevren
- Department of Neurosurgery, Ministry of Health, Kirikkale Yüksek Ihtisas Hospital, Baglarbasi mh. Lokman Hekim cd., Kirikkale, Turkey
| | - Erhan Turkoglu
- Department of Neurosurgery, Ministry of Health, Diskapi Yildirim Beyazit Education and Research Hospital, Irfan Bastug cd., Diskapi, Ankara, Turkey
| | - Aysun Gökçe
- Department of Pathology, Ministry of Health, Diskapi Yildirim Beyazit Education and Research Hospital, Irfan Bastug cd., Diskapi, Ankara, Turkey
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Li C, Wang H, Liu H, Yin J, Cui L, Chen Z. The prevention effect of poly (L-glutamic acid)/chitosan on spinal epidural fibrosis and peridural adhesion in the post-laminectomy rabbit model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:2423-31. [PMID: 25001891 DOI: 10.1007/s00586-014-3438-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 06/21/2014] [Accepted: 06/22/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE Spinal epidural fibrosis and adhesion are implicated as one of the key factors of failed back surgery syndrome, which may cause dura mater compression or peridural tethering, resulting in persistent backache and leg pain. Various materials or drugs have been used to inhibit formation of epidural fibrosis and reduce the compressive effect on neural structures. Nevertheless, the effects are not satisfied. In this study, we investigated the prevention effect of poly (L-glutamic acid)/chitosan (PLGA/CS) barrier on epidural fibrosis developing post-laminectomy in a rabbit model. METHODS Sixteen rabbits were divided randomly into two equal groups: group A (experimental group, n = 8) and group B (non-treatment group, n = 8). In both groups, total L5-6 laminectomy was performed; further both ligamentum flavum and epidural fat were removed gently. In experimental group, the laminectomy sites were treated with PLGA/CS barriers, while no additional treatment was received in non-treatment group. At 1, 12 and 24 weeks post-surgery, the animals were subjected to magnetic resonance imaging (MRI) evaluation. Following last MRI examination, all rabbits were sacrificed and their spinal columns were totally removed for further macroscopic and histological evaluation. RESULTS MRI showed that rabbits treated with PLGA/CS barrier at 12 and 24 weeks post-surgery had less epidural fibrosis or scar tissue, peridural adhesion, foreign body reaction and low pressure of spinal cord in comparison with the non-treatment group. In consistence with the radiographic results, macroscopic analysis and histological examination showed that the amount of scar tissue and the extent of epidural adhesion decreased significantly in experimental groups. Concerning the fibroblast density evaluated, the scores were significantly lower in experimental group compared with those in non-treatment group. CONCLUSION The results of our study demonstrate that PLGA/CS barrier is effective in inhibiting epidural fibrosis and peridural adhesions in post-laminectomy rabbit model.
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Affiliation(s)
- Chunbo Li
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Feng Lin Road No. 180, XuHui District, Shanghai, 200032, People's Republic of China
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Zeinalizadeh M, Miri SM, Ardalan FA, Maleki F, Zakeri M, Aghajanzadeh E, Habibi Z. Reduction of epidural fibrosis and dural adhesions after lamina reconstruction by absorbable cement: an experimental study. Spine J 2014; 14:113-8. [PMID: 23999230 DOI: 10.1016/j.spinee.2013.06.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Post-laminectomy epidural fibrosis complicates revision spine surgery and is implicated in cases of "failed back syndrome." Several materials have been used to minimize epidural fibrosis with varying results. PURPOSE The aim of this study was to examine the impact of reconstruction of laminectomy site with a type of absorbable cement (Jectos) to reduce epidural fibrosis. STUDY DESIGN This investigation is an experimental controlled study, which is designed to evaluate the preventive effects of laminectomy site reconstruction in rat laminectomy model. METHODS Twenty wistar rats were included in this study and divided randomly to two equal groups, namely, subject and control. In both groups, laminectomy was performed in L2 and L4 levels. Control group received no additional treatment. In the subject group, L4 levels were reconstructed by Jectos and L2 levels were non-reconstructed as internal controls. Six months after surgery the rats were sacrificed and the dural adhesion and epidural fibrosis were evaluated macroscopically and microscopically. The study was financially supported by Brain and Spinal Cord Injuries Repair Center. None of the authors have any conflict of interest. RESULTS Non-reconstructed levels in both groups showed dense epidural fibrosis with marked dural adherence. L4 reconstructed levels in subject group showed reduced epidural fibrosis macroscopically (p=.024) and microscopically (p=.041). No foreign body reaction or ossification occurred at reconstructed sites. CONCLUSIONS In the present study, lamina reconstruction with absorbable cement was a safe method that significantly reduced post-laminectomy epidural fibrosis and dural adhesions in rat laminectomy model.
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Affiliation(s)
- Mehdi Zeinalizadeh
- Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1419733141, Iran; Brain and Spinal Cord Injuries Repair Research Center, Imam Khomeini Hospital, Tehran 1419733141, Iran.
| | - Seyed Mojtaba Miri
- Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1419733141, Iran; Brain and Spinal Cord Injuries Repair Research Center, Imam Khomeini Hospital, Tehran 1419733141, Iran
| | - Farid Azmoodeh Ardalan
- Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1419733141, Iran
| | - Farid Maleki
- Brain and Spinal Cord Injuries Repair Research Center, Imam Khomeini Hospital, Tehran 1419733141, Iran
| | - Marjan Zakeri
- Brain and Spinal Cord Injuries Repair Research Center, Imam Khomeini Hospital, Tehran 1419733141, Iran
| | - Elham Aghajanzadeh
- Brain and Spinal Cord Injuries Repair Research Center, Imam Khomeini Hospital, Tehran 1419733141, Iran
| | - Zohreh Habibi
- Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1419733141, Iran; Brain and Spinal Cord Injuries Repair Research Center, Imam Khomeini Hospital, Tehran 1419733141, Iran
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Prevention of peridural fibrosis using a cyclooxygenase-2 inhibitor (nonsteroidal anti-inflammatory drug) soaked in absorbable gelatin sponge: an experimental comparative animal model. Spine (Phila Pa 1976) 2013; 38:E985-91. [PMID: 23615385 DOI: 10.1097/brs.0b013e318297c795] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Experimental study. OBJECTIVE To evaluate the efficacy and safety of peridural parecoxib-soaked absorbable gelatin sponge, and cellulose membrane on peridural fibrosis prevention in an animal model. SUMMARY OF BACKGROUND DATA Postoperative peridural fibrosis is one of the causes of failed back surgery syndrome. Nonsteroidal anti-inflammatory drugs inhibit the inflammatory response, while an absorbable gelatin sponge or cellulose membrane interposes between the dura and the paraspinal muscle to staunch the surgical bleeding. These mechanisms may prevent peridural fibrosis. METHODS Forty L5-L6 laminectomized adult Sprague-Dawley rats were randomly allocated into 4 groups. The high parecoxib group received 6 mg of parecoxib soaked into an absorbable gelatin sponge placed over the dura. The low parecoxib group was given 2 mg of parecoxib soaked into an absorbable gelatin sponge. The dura in the cellulose group was covered with a cellulose membrane, while the control group received normal saline drip before surgical wound closure. All rats were killed at 6 weeks for histopathological assessment. The fibroblast density, inflammatory cell density, fibrous adherence, and adverse events were quantified. The obtained results were analyzed statistically. RESULTS The respective mean fibroblast density in the high parecoxib, low parecoxib, cellulose, and control groups was 217.77 ± 51.76, 317.51 ± 126.92, 321.80 ± 90.94, and 328.48 ± 73.41 cells/mm², while the respective mean inflammatory cell density was 539.65 ± 236.52, 910.17 ± 242.59, 1011.84 ± 239.30, and 1261.78 ± 319.68 cells/mm². The mean fibroblast and inflammatory cell densities of the high parecoxib group were significantly lower than the control. The high parecoxib group also showed statistically less fibrous adherence than low parecoxib, cellulose, and control groups. CONCLUSION The high-dose parecoxib-soaked absorbable gelatin sponge can prevent peridural fibrosis without complications. The low-dose parecoxib and cellulose membrane provided no significant benefit vis-à-vis prevention of peridural fibrosis, as adduced from the lack of any statistically significant difference between the test and control rats.
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The effectiveness of poloxamer 407-based new anti-adhesive material in a laminectomy model in rats. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:971-9. [PMID: 22160098 DOI: 10.1007/s00586-011-2098-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 11/17/2011] [Accepted: 11/22/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE In the laminectomy model in rats, to verify anti-adhesive effectiveness of the new material, a mixture composed of poloxamer 407, calcium chloride, and xanthorrhizol, we compared it with that of commercially used solution form anti-adhesive agent GUARDIX-SL, Biorane. MATERIALS AND METHODS A total of 108 Sprague-Dawley rats (SD rats) were divided equally into three groups: negative control group (NCG), positive control group (PCG), and experimental group (EG). After exposing the dura on L4 level, we closed the wound shortly after hemostasis, after administering the anti-adhesive agent. To evaluate effectiveness, 18 SD rats from each group were killed after 1 week of rearing. Nine were examined by grading of gross adhesion and the other nine, by grading of histological adhesion. The degree of adhesion in the remainder of 18 SD rats in each group was examined with the same method after four weeks of rearing. RESULTS Comparing the degree of adhesion after growth for 1 week, the gross and histological adhesion of the EG was lower than that of the NCG. There was no statistical significance in the gross score (P = 0.63), but there was statistical significance in the histological score (P = 0.04). The EG showed similar or improved degrees of adhesion in comparison with the PCG. In comparison after growth for 4 weeks, although gross adhesion of the EG was not significantly lower than the NCG, histological adhesion was remarkably low in the EG (P = 0.01). The EG showed similar or improved degrees of gross and histological adhesion in comparison to that of the PCG. (P = 0.20, 0.07). CONCLUSION The new anti-adhesive material showed similar or improved effectiveness with the existing agents for commercial use. This result suggests that the new anti-adhesive material will be a successful candidate as a future product for clinical use.
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Lee JH, Jeong BO. The effect of hyaluronate-carboxymethyl cellulose on bone graft substitute healing in a rat spinal fusion model. J Korean Neurosurg Soc 2011; 50:409-14. [PMID: 22259686 DOI: 10.3340/jkns.2011.50.5.409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 07/26/2011] [Accepted: 11/14/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of sodium hyaluronate-sodium carboxymethyl cellulose (HA-CMC), an anti-adhesive material for spinal surgery, on bone fusion by applying it to rat spinal models after lumbar posterolateral fusion. METHODS Lumbar posterolateral fusion was performed at L4-5 using bone graft substitutes in 30 rats. HA-CMC was injected in 15 rats at a dose of 0.2 cc (HA-CMC group) and a saline solution of 0.2 cc in the other 15 rats (control group). Simple radiographs were taken until postoperative 9 weeks with an interval of one week. At postoperative 4 and 9 weeks, three dimensional computed tomography (3D CT) scanning was performed to observe the process of bone fusion. At 9 weeks, bone fusion was confirmed by gross examination and manual palpation. RESULTS There were no statistically significant differences in bone fusion between the two groups. 3D CT scanning did not reveal significant differences between the groups. The gross examination and manual palpation after autopsy performed at 9 weeks confirmed bone union in 93.3% of both groups. CONCLUSION The anti-adhesive material used for spinal surgery did not have adverse effects on spinal fusion in rats.
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Affiliation(s)
- Jung Hee Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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The Effects of Seprafilm and Interceed TC7 on Epidural Fibrosis in a Rat Hemilaminectomy Model. ACTA ACUST UNITED AC 2009. [DOI: 10.1097/wnq.0b013e3181b0cfc8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Comparison of the Effectiveness of Waxed Paper and Gore-Tex on the Minimally Invasive Epidural Fibrosis Model. ACTA ACUST UNITED AC 2009; 22:49-51. [DOI: 10.1097/bsd.0b013e31815e6d28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Comparison of Oxiplex and Gore-Tex effectivity in an experimental peridural fibrosis model. Neurocirugia (Astur) 2009; 20:360-6. [DOI: 10.1016/s1130-1473(09)70155-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
STUDY DESIGN Review of Literature. OBJECTIVE To review the published literature regarding revision lumbar total disc arthroplasty as well as potential options to avoid complications associated with the revision surgical approach. SUMMARY OF BACKGROUND DATA The use of lumbar total disc arthroplasty in the United States has not achieved the same popularity as seen in Europe, where studies have reported favorable short- and intermediate-term results. In the United States, despite recognition that disc replacement may reduce the incidence of adjacent segment disease, the risk of potential complications associated with primary and revision total disc arthroplasty have diminished surgeon enthusiasm for the procedure. The use of adhesion barriers may address some of these concerns. METHODS A series of Ovid Medline and Pubmed-National Library of Medicine/National Institutes of Health (www.ncbi.nlm.nih.gov) searches were performed. Only articles written in English journals or published with English translations were included. Level of evidence of the selected articles was assessed. RESULTS The need for revision of lumbar total disc arthroplasty has been reported in a number of prospective, randomized trials (level I or II evidence). Suboptimal patient selection and/or surgical technique accounted for the majority of failed disc arthroplasties. Revision procedures have included posterior stabilization or anterior explantation with revision to arthroplasty or conversion to arthrodesis. The risk of injury to the great vessels and retroperitoneal structures is greater during revision than primary procedures. The use of a far lateral, or transpsoas approach to the anterior column may reduce these adverse events. The use of adhesion barriers has been shown to reduce adhesions in abdominal and pelvic surgery and may be of benefit in revision disc arthroplasty. CONCLUSION Adherence to stringent indications and meticulous surgical technique may reduce the number ofrevision procedures. Further, the use of barriers to adhesion formation during the primary arthroplasty may also reduce risk to the retroperitoneal structures during revision approaches.
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