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Romero-Muñoz LM, Barriga-Martín A, Del Cerro de Pablo P, Rodríguez de Lope A, Alves-Sampaio A, Collazos-Castro JE. Effects of duroplasty with bovine pericardium on fibrosis and extent of spinal cord injury: An experimental study in pigs. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:390-397. [PMID: 37802396 DOI: 10.1016/j.recot.2023.09.008] [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: 05/22/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Traumatic spinal cord injury (SCI) leads to increased intraspinal pressure that can be prevented by durotomy and duroplasty. The aim of the study was to evaluate fibrosis and neural damage in a porcine model of SCI after duroplasty and application of hyaluronic acid (HA) in the tissue cavity. MATERIALS AND METHODS Experimental study. We created a porcine SCI model by durotomy and spinal cord hemisection of a cervical segment (1cm). Six pigs (Sus scrofa domestica) were used to evaluate three surgical scenarios: (1)control injury with dural reparative microsurgery, (2)duroplasty using bovine pericardium (BPD), and (3)previous method plus HA applied at the lesion. Animals were sacrificed one-month post-injury to assess fibrotic responses and neural tissue damage using conventional histological and immunohistochemical methods. RESULTS In the control case, dural suture prevented invasion of the lesion by extradural connective tissue, and the dura mater showed a 1-mm thickening in the perilesional area. The bovine pericardium patch blocked the entrance of extradural connective tissue, decreased dura-mater tension, and satisfactorily integrated within the receptor tissue. However, it also enhanced subdural and perilesional fibrosis, which was not inhibited by filling the lesion cavity with low- or high-molecular-weight HA. CONCLUSIONS Duroplasty prevents collapse of the dura-mater over the spinal cord tissue, as well as invasion of the lesion by extramedullary fibrotic tissue, without creating additional neural damage. Nevertheless, it enhances the fibrotic response in the spinal cord lesion and the perilesional area. Additional antifibrotic strategies are needed to facilitate spinal cord repair.
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Affiliation(s)
- L M Romero-Muñoz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, España.
| | - A Barriga-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, España
| | - P Del Cerro de Pablo
- Unidad de Reparación Neural y Biomateriales, Hospital Nacional de Parapléjicos, Toledo, España
| | | | - A Alves-Sampaio
- Unidad de Reparación Neural y Biomateriales, Hospital Nacional de Parapléjicos, Toledo, España
| | - J E Collazos-Castro
- Unidad de Reparación Neural y Biomateriales, Hospital Nacional de Parapléjicos, Toledo, España
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Romero-Muñoz LM, Barriga-Martín A, Del Cerro de Pablo P, Rodríguez de Lope A, Alves-Sampaio A, Collazos-Castro JE. [Translated article] Effects of duroplasty with bovine pericardium on fibrosis and extent of spinal cord injury: An experimental study in pigs. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T390-T397. [PMID: 38325568 DOI: 10.1016/j.recot.2024.01.026] [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: 05/22/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Traumatic spinal cord injury (SCI) leads to increased intraspinal pressure that can be prevented by durotomy and duroplasty. The aim of the study was to evaluate fibrosis and neural damage in a porcine model of SCI after duroplasty and application of hyaluronic acid (HA) in the tissue cavity. MATERIALS AND METHODS Experimental study. We created a porcine SCI model by durotomy and spinal cord hemisection of a cervical segment (1cm). Six pigs (Sus scrofa domestica) were used to evaluate three surgical scenarios: (1) control injury with dural reparative microsurgery, (2) duroplasty using bovine pericardium (BPD), and (3) previous method plus HA applied at the lesion. Animals were sacrificed one-month post-injury to assess fibrotic responses and neural tissue damage using conventional histological and immunohistochemical methods. RESULTS In the control case, dural suture prevented invasion of the lesion by extradural connective tissue, and the dura mater showed a 1-mm thickening in the perilesional area. The bovine pericardium patch blocked the entrance of extradural connective tissue, decreased dura-mater tension, and satisfactorily integrated within the receptor tissue. However, it also enhanced subdural and perilesional fibrosis, which was not inhibited by filling the lesion cavity with low- or high-molecular-weight HA. CONCLUSIONS Duroplasty prevents collapse of the dura-mater over the spinal cord tissue, as well as invasion of the lesion by extramedullary fibrotic tissue, without creating additional neural damage. Nevertheless, it enhances the fibrotic response in the spinal cord lesion and the perilesional area. Additional antifibrotic strategies are needed to facilitate spinal cord repair.
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Affiliation(s)
- L M Romero-Muñoz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, Spain.
| | - A Barriga-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - P Del Cerro de Pablo
- Unidad de reparación neural y biomateriales, Hospital Nacional de Parapléjicos, Toledo, Spain
| | | | - A Alves-Sampaio
- Unidad de reparación neural y biomateriales, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - J E Collazos-Castro
- Unidad de reparación neural y biomateriales, Hospital Nacional de Parapléjicos, Toledo, Spain
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Godek P, Ptaszkowski K. Safety of Epidural Hyaluronic Acid Injections in Managing the Symptoms of Lumbar Foraminal Stenosis: A Prospective Preliminary Study. J Clin Med 2023; 12:jcm12062359. [PMID: 36983359 PMCID: PMC10052817 DOI: 10.3390/jcm12062359] [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: 02/16/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Lumbar foraminal stenosis (LFS) of degenerative origin is a common reason for distorted neurodynamics of nerve roots, causing radicular pain that is difficult to resolve with conservative treatments. A hyaluronic acid (HA), providing a sliding layer in the mechanical interface of a nerve root in a narrowed lateral recess, could potentially improve its neurodynamics and the trophic, leading to radicular pain reduction and improvement of function. This study aimed to assess the usefulness of ultrasound-guided HA epidural injections combined with neuromobilization in the conservative treatment of LFS. A group of 10 consecutively admitted patients with MRI-confirmed LFS and reduced straight leg raise (SLR) test results were qualified for a single HA epidural injection along with self-performed neuromobilization. Three measurement tools were used for primary outcomes: the numeric rating scale (NRS) for pain intensity, the Oswestry disability index (ODI) and the Roland-Morris questionnaire (RMQ) for disability level, and the angle of pain-free elevation in the SLR test as a functional assessment. The treatment was accomplished in all patients (100%). Overall, 60% of the patients completed all follow-up visits. There were no statistically significant differences regarding the results of the NRS, ODI, or RMQ; however, a statistically significant increase in the results of the SLR test was noted (p = 0.015). Three patients reported a flare-up of the symptoms shortly after injection but without neurological deficits. In conclusion, an epidural HA injection combined with a self-administered exercise program is a promising method and might be a beneficial way to enhance the neurodynamics of nerve roots in LFS and offer an option for steroid treatment. However, this method of epidural HA administration in LFS should be verified in further studies to confirm its efficiency and safety.
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Affiliation(s)
- Piotr Godek
- Sutherland Medical Center, 04-036 Warsaw, Poland
| | - Kuba Ptaszkowski
- Department of Physiotherapy, Wroclaw Medical University, 50-368 Wrocław, Poland
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Bone Formation on Murine Cranial Bone by Injectable Cross-Linked Hyaluronic Acid Containing Nano-Hydroxyapatite and Bone Morphogenetic Protein. Polymers (Basel) 2022; 14:polym14245368. [PMID: 36559734 PMCID: PMC9783206 DOI: 10.3390/polym14245368] [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: 10/14/2022] [Revised: 11/20/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
New injection-type bone-forming materials are desired in dental implantology. In this study, we added nano-hydroxyapatite (nHAp) and bone morphogenetic protein (BMP) to cross-linkable thiol-modified hyaluronic acid (tHyA) and evaluated its usefulness as an osteoinductive injectable material using an animal model. The sol (ux-tHyA) was changed to a gel (x-tHyA) by mixing with a cross-linker. We prepared two sol−gel (SG) material series, that is, x-tHyA + BMP with and without nHAp (SG I) and x-tHyA + nHAp with and without BMP (SG II). SG I materials in the sol stage were injected into the cranial subcutaneous connective tissues of mice, followed by in vivo gelation, while SG II materials gelled in Teflon rings were surgically placed directly on the cranial bones of rats. The animals were sacrificed 8 weeks after implantation, followed by X-ray analysis and histological examination. The results revealed that bone formation occurred at a high rate (>70%), mainly as ectopic bone in the SG I tests in mouse cranial connective tissues, and largely as bone augmentation in rat cranial bones in the SG II experiments when x-tHyA contained both nHAp and BMP. The prepared x-tHyA + nHAp + BMP SG material can be used as an injection-type osteoinductive bone-forming material. Sub-periosteum injection was expected.
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Yue Z, Hu B, Chen Z, Zheng G, Wang Y, Yang C, Cao P, Wu X, Liang L, Zang F, Wang J, Li J, Zhang T, Wu J, Chen H. Continuous release of mefloquine featured in electrospun fiber membranes alleviates epidural fibrosis and aids in sensory neurological function after lumbar laminectomy. Mater Today Bio 2022; 17:100469. [PMCID: PMC9633751 DOI: 10.1016/j.mtbio.2022.100469] [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: 08/25/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
Recurrent low back pain after spinal surgeries, such as lumbar laminectomy, is a major complication of excessive epidural fibrosis. Although multiple preclinical and clinical methods have been aimed at ameliorating epidural fibrosis, their safety and efficacy remain largely unclear. Single implanted electrospun fibrous membranes provide physical barriers that can decrease tissue fibrosis after surgery; however, they also trigger local inflammation due to the implantation of a foreign body, thus subsequently attenuating their anti-fibrosis properties. Here, we designed a strategy that permits easy incorporation of mefloquine into polylactic acid membranes, and stable long-term mefloquine release, to potentially improve anti-fibrosis effects and relieve or prevent low back pain. The electrospun fibrous membranes grafted with mefloquine showed a well-controlled early temporary peak release, and secondary drug release occurred smoothly over several weeks. Histopathological and histomorphometric results indicated that the drug-loaded membranes had excellent anti-fibrosis effects after laminectomy in rats. Inflammation and neovascularization at the surgical site indicated that the mefloquine-grafted electrospun fibrous membranes provided sustained anti-inflammatory outcomes while effectively alleviating associated neuropathic pain hypersensitivity. In summary, our study indicated that polylactic acid-mefloquine grafted electrospun fibrous membranes may be a potential local agent to mitigate epidural fibrosis and support sensory neurological function after laminectomy, thereby potentially improving patients’ postoperative outcomes.
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Affiliation(s)
- Zhihao Yue
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Bo Hu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhe Chen
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, China
| | - Genjiang Zheng
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yunhao Wang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Chen Yang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Peng Cao
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xiaodong Wu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Lei Liang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Fazhi Zang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jianxi Wang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jing Li
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China,Department of Bioinformatics, Center for Translational Medicine, Naval Medical University, Shanghai, 200433, China
| | - Tao Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 200030, Shanghai, China,Corresponding author.
| | - Jinglei Wu
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, China,Corresponding author. College of Biological Science and Medical Engineering, Donghua University, Shanghai, China.
| | - Huajiang Chen
- Spine Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China,Corresponding author. Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China.
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Photo-Crosslinked Hyaluronic Acid/Carboxymethyl Cellulose Composite Hydrogel as a Dural Substitute to Prevent Post-Surgical Adhesion. Int J Mol Sci 2022; 23:ijms23116177. [PMID: 35682853 PMCID: PMC9181059 DOI: 10.3390/ijms23116177] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 02/01/2023] Open
Abstract
A dural substitute is frequently used to repair dura mater during neurosurgical procedures. Although autologous or commercially available dural substitutes matched most of the requirements; difficulties during dural repair, including insufficient space for suturing, insufficient mechanical strength, easy tear and cerebrospinal fluid leakage, represent major challenges. To meet this need, a photo-crosslinked hydrogel was developed as a dural substitute/anti-adhesion barrier in this study, which can show sol-to-gel phase transition in situ upon short-time exposure to visible light. For this purpose, hyaluronic acid (HA) and carboxymethyl cellulose (CMC), materials used in abdominal surgery for anti-adhesion purposes, were reacted separately with glycidyl methacrylate to form hyaluronic acid methacrylate (HAMA) and carboxymethyl cellulose methacrylate (CMCMA). The HA/CMC (HC) hydrogels with different HA compositions could be prepared by photo-crosslinking HAMA and CMCMA with a 400 nm light source using lithium phenyl-2,4,6-trimethylbenzoylphosphinate as a photo-initiator. From studies of physico-chemical and biological properties of HC composite hydrogels, they are bio-compatible, bio-degradable and mechanically robust, to be suitable as a dural substitute. By drastically reducing attachment and penetration of adhesion-forming fibroblasts in vitro, the HC hydrogel can also act as an anti-adhesion barrier to prevent adhesion formation after dural repair. From in vivo study in rabbits, the HC hydrogel can repair dural defects as well as protect the dura from post-operative adhesion, endorsing the possible application of this hydrogel as a novel dural substitute.
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Chen X, Wang S, Li Y, Lin C, Liu X. Assessment of the anesthetic effect of modified pentothal sodium solution on Sprague-Dawley rats. Open Life Sci 2022; 17:483-487. [PMID: 35647301 PMCID: PMC9102301 DOI: 10.1515/biol-2022-0050] [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: 08/08/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Clinically, pentothal sodium has been widely used for primary and general anesthesia induction. Also, it has been used to effectively inhibit convulsion. Pentothal sodium has a strong inhibitory effect on the respiratory center, excessive drug administration, and rapid dose rate that cause death of experimental animals on the respiratory depression. This study used a modified pentothal sodium solution to investigate its anesthetic effect. The pentothal sodium solution was modified based on pentothal sodium upon additions of magnesium sulfate, propylene glycol, and pure ethanol. The anesthetic effect of the modified pentothal sodium on Sprague–Dawley (SD) rats was investigated by comparing traditional pentothal sodium and ketamine; 60 SD rats were randomly divided into three groups. Each group was treated with traditional pentothal sodium, modified pentothal sodium, or ketamine, respectively, via intraperitoneal injection. The symptoms of experimental rats were observed, and onset time and anesthetic time were both recorded. The data were analyzed using statistical software. There were no significant differences in onset time and anesthetic time between the three groups. The variation of onset time and anesthetic time of the group treated with modified pentothal sodium was shorter than that of the other two groups. Furthermore, the number of anesthetic rats after the first injection was significantly higher than that of the other two groups. The modified pentothal sodium is capable of providing a stable anesthetic effect. The function and effect are much better than traditional pentothal sodium and ketamine.
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Affiliation(s)
- Xianzhen Chen
- Department of Anesthesia, Women and Children’s Hospital Affiliated to Xiamen University , 10 Zhenhai Road, Siming , Xiamen , 361001 , People’s Republic of China
| | - Shiqing Wang
- Department of Anesthesia, Women and Children’s Hospital Affiliated to Xiamen University , 10 Zhenhai Road, Siming , Xiamen , 361001 , People’s Republic of China
| | - Youjiong Li
- Department of Anesthesia, Women and Children’s Hospital Affiliated to Xiamen University , 10 Zhenhai Road, Siming , Xiamen , 361001 , People’s Republic of China
| | - Chunjin Lin
- Department of Anesthesia, Women and Children’s Hospital Affiliated to Xiamen University , 10 Zhenhai Road, Siming , Xiamen , 361001 , People’s Republic of China
| | - Xiaofang Liu
- Department of Anesthesia, Women and Children’s Hospital Affiliated to Xiamen University , 10 Zhenhai Road, Siming , Xiamen , 361001 , People’s Republic of China
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Liu X, Zhang F, Li L, He Y, Dong Y. Reconstruction of Epidural Fat to Prevent Epidural Fibrosis After Laminectomy in Rabbits. Tissue Eng Part A 2022; 28:366-372. [PMID: 34569267 DOI: 10.1089/ten.tea.2021.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Laminectomy can effectively decompress the spinal cord and expand the vertebral canal. However, the fibrosis that appears may cause adherence and recompression of the spinal cord or/and nerve root, which may cause failed back syndrome (FBS) and make the reexposure process more difficult. Reconstruction of the epidural fat may be an ideal method to achieve satisfactory results. Methods: Thirty-six New Zealand rabbits were randomly divided into three groups: control, extracellular matrix (ECM), and ECM+aMSCs groups. Saline, ECM gel, and ECM+aMSC complex were placed, respectively, at the fifth lumbar vertebrate of the rabbits. Epidural fat and fibrosis formation were detected by magnetic resonance imaging (MRI) and histologically at the 4th, 8th, and 12th weeks. Quantitative RT-PCR was used to detect the expression of interleukin 6 (IL-6) and transforming growth factor β (TGF-β). Results: MRI and Oil Red O staining revealed epidural fat formation at the 12th week in the ECM+aMSCs group. Hematoxylin and eosin staining showed that the numbers of fibroblasts in the ECM gel and ECM+aMSCs groups were less than the control group at the 4th and 8th weeks (p < 0.05). Masson's trichrome staining showed that the proportion of collagen fibers in the ECM gel and ECM+aMSCs group was lower than the control group (p < 0.05). Quantitative RT-PCR showed the expressions of TGF-β and IL-6 were lower in the ECM gel and ECM+aMSCs group than those in the control group (p < 0.05) at the 4th week, but higher at the 8th week. Conclusion: We successfully reconstructed the epidural fat with ECM gel and aMSC complex; additionally, IL-6 and TGF-β cytokines were lower at early stage after laminectomy.
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Affiliation(s)
- Xiangsheng Liu
- Department of Orthopedics, The Fifth People's Hospital of Fudan University, Shanghai, China
| | - Feifei Zhang
- Department of Orthopedics, Shanghai Xuhui DaHua Hospital, Shanghai, China
| | - Linli Li
- Department of Orthopedics, The Fifth People's Hospital of Fudan University, Shanghai, China
| | - Yiqun He
- Department of Orthopedics, The Fifth People's Hospital of Fudan University, Shanghai, China
| | - Youhai Dong
- Department of Orthopedics, The Fifth People's Hospital of Fudan University, Shanghai, China
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The effectiveness of spatially cross-linked polymer in the postoperative epidural fibrosis prevention: an experimental study. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction. Epidural fibrosis is an urgent problem in modern spinal surgery and orthopedics. The formation of connective tissue in the epidural space after performing surgical interventions on the spinal column inevitably leads to adhesion of the latter to the dura mater and compression of neural structures, followed by the formation of clinical and neurological symptoms. The search for literary sources in domestic and foreign scientific databases has demonstrated the presence of several works studying the effectiveness of barrier methods for preventing the development of epidural fibrosis. It should be noted that the results of these studies are ambiguous and largely contradictory.The purpose was to study the effectiveness of using a spatially cross-linked polymer in the postoperative lumbar epidural fibrosis prevention in an experiment.Materials and methods. The study included 26 male Wistar rats (average body weight 338.5±9.07 g), which were divided into two groups: Group I (control, n = 12): animals underwent laminectomy at the level of vertebral bodies LVII – SI without application of spatially crosslinked polymer; Group II (experimental, n = 14): animals underwent laminectomy at the level of vertebral bodies LVII – SI followed by application of a spatially cross-linked polymer to the dura mater. The morphological and instrumental parameters were studied.Results. Significant differences were noted in the severity of epidural fibrosis (χ2 = 14.846, p = 0.003), the number of newly formed vessels (F = 14.371, p<0.001), the number of fibroblasts (F = 11.158, p<0.001), as well as in the severity of vertebral stenosis channe l according to multislice computed tomography (χ2 = 17.207, p=0.002) between the control and experimental groups of animals.Conclusion. Application of a spatially cross-linked polymer to the dura mater is an effective way to prevent the development of postoperative epidural fibrosis.
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Abdelrahman KA, Ibrahim AS, Osman AM, Aly MG, Ali AS, Farrag WS. Alpha lipoic acid with pulsed radiofrequency in treatment of chronic lumbosacral radicular pain: A prospective, randomized study. Medicine (Baltimore) 2021; 100:e26344. [PMID: 34128884 PMCID: PMC8213315 DOI: 10.1097/md.0000000000026344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The effect of adding alpha lipoic acid (ALA) to pulsed radiofrequency (PRF) for treatment of lumbar-sacral pain was evaluated. OBJECTIVE to evaluate the effect of using ALA as an adjuvant therapy with PRF for treatment of chronic lumbosacral radicular pain caused by herniated disc. METHODS One hundred twenty patients with lumbo-sacral radicular pain allocated into 2 groups. Group I: treated with PRF at 42°C for 120 seconds. Group II: treated as in group I, plus oral ALA 600 mg (Thiotacid 600 mg, EVA PHARMA, Egypt) three times per day (1800 mg/day) for 3 weeks then 600 mg once daily for 2 weeks. The lumbo-sacral radicular pain evaluated using the numerical rating pain score and Oswestry Disability Index. RESULTS Success rate was significantly higher in group II at 3 and 6 months after intervention. The median values of the numerical rating pain score and the Oswestry Disability Index were significantly lower in group II with no significant difference in Epworth Sleepiness Scale. No major complications were reported in both groups. CONCLUSION The current study supports the use of ALA with PRF on the dorsal root ganglion for treating lumbosacral radicular pain.
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Monavarian M, Kader S, Moeinzadeh S, Jabbari E. Regenerative Scar-Free Skin Wound Healing. TISSUE ENGINEERING PART B-REVIEWS 2020; 25:294-311. [PMID: 30938269 DOI: 10.1089/ten.teb.2018.0350] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPACT STATEMENT Millions of people every year develop scars in response to skin injuries after surgery, trauma, or burns with significant undesired physical and psychological effects. This review provides an update on engineering strategies for scar-free wound healing and discusses the role of different cell types, growth factors, cytokines, and extracellular components in regenerative wound healing. The use of pro-regenerative matrices combined with engineered cells with less intrinsic potential for fibrogenesis is a promising strategy for achieving scar-free skin tissue regeneration.
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Affiliation(s)
- Mehri Monavarian
- 1Biomimetic Materials and Tissue Engineering Laboratory, Department of Chemical Engineering, University of South Carolina, Columbia, South Carolina
| | - Safaa Kader
- 1Biomimetic Materials and Tissue Engineering Laboratory, Department of Chemical Engineering, University of South Carolina, Columbia, South Carolina.,2Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina
| | - Seyedsina Moeinzadeh
- 1Biomimetic Materials and Tissue Engineering Laboratory, Department of Chemical Engineering, University of South Carolina, Columbia, South Carolina
| | - Esmaiel Jabbari
- 1Biomimetic Materials and Tissue Engineering Laboratory, Department of Chemical Engineering, University of South Carolina, Columbia, South Carolina
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Wang K, Li XL, Liu J, Sun X, Yang H, Gao X. Using cross-linked hyaluronic acid gel to prevent postoperative lumbar epidural space adhesion: in vitro and in vivo studies. 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 2019; 29:129-140. [PMID: 31630264 DOI: 10.1007/s00586-019-06193-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/23/2019] [Accepted: 10/13/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Hyaluronic acid prevents tissue adhesion after different surgeries. Physical barriers and inflammatory regulation have been suggested to be involved in the mechanism of these clinical effects. However, the molecular mechanism by which hyaluronic acid prevents epidural adhesion has not yet been reported. METHODS In the current in vivo studies, we investigated cross-linked hyaluronic acid gel in the regulation of scar gene expression, the accumulation of fibroblasts in scar tissue, and the prevention of epidural adhesion. The effect of cross-linked hyaluronic acid gel on the secretion of inflammatory factors was observed in vitro. In addition, to ensure the accuracy and reliability of the in vivo gene expression results, we used a cell model to detect the target genes in vitro. RESULTS The expression levels of TGFβ1 and COL1A1 mRNA were decreased in the cross-linked hyaluronic acid gel-treated group, and the protein expression of levels TGFβ1 and COL1A1 were also reduced, as detected by Western blotting in vitro and in vivo (P < 0.05). Histomorphometry results demonstrated that the number of fibroblasts in the experimental group was significantly lower than that in the control group 2 weeks postoperatively. Micro-CT scans showed that the cross-linked hyaluronic acid gel could reduce adhesion in the epidural space after laminectomy. Additionally, the cross-linked hyaluronic acid gel could inhibit IL-6 secretion. CONCLUSIONS These results indicate that cross-linked hyaluronic acid gel can prevent epidural adhesion by inhibiting inflammatory factors, such as IL-6, and downregulating TGFβ1 and COL1A1 mRNA expression. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Kun Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Department of Orthopedics, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Xiao Long Li
- Department of Orthopedics, The People's Hospital of Wujin Affiliated with Jiangsu University, Changzhou, 213017, China
| | - Jinbo Liu
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Xiaoliang Sun
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Xin Gao
- Department of Orthopedics, The People's Hospital of Wujin Affiliated with Jiangsu University, Changzhou, 213017, China.
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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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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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Wang B, Li P, Shangguan L, Ma J, Mao K, Zhang Q, Wang Y, Liu Z, Mao K. A novel bacterial cellulose membrane immobilized with human umbilical cord mesenchymal stem cells-derived exosome prevents epidural fibrosis. Int J Nanomedicine 2018; 13:5257-5273. [PMID: 30237713 PMCID: PMC6136916 DOI: 10.2147/ijn.s167880] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Failed back surgery syndrome is a situation where there is failure after lumbar surgery aimed at correcting lumbar disease that is characterized by continuous back and/or leg pain. Epidural fibrosis and adhesions are among the major causes of failed back surgery syndrome. In recent years, several biomaterials have been applied as barriers or deterrents to prevent the compression of neural structures by postsurgical fibrosis. Methods In this study, a new bacterial cellulose (BC) anti-adhesion membrane, composed of exosomes from human umbilical cord mesenchymal stem cells, was developed. Its structure and morphology, water content, thickness, and mechanical properties of elasticity were analyzed and characterized. The degradation of the BC+exosomes (BC+Exos) membrane in vitro was evaluated, and its in vitro cytotoxicity and in vivo biocompatibility were tested. The prevention effect of BC+Exos membrane on epidural fibrosis post-laminectomy in a rabbit model was investigated. Results The BC+Exos membrane showed a three-dimensional network structure constituted of high-purity cellulose and moderate mechanical properties. No degeneration was observed. The BC+Exos membrane showed no cytotoxicity and displayed biocompatibility in vivo. The BC+Exos film was able to inhibit epidural fibrosis and peridural adhesions. Conclusion Based on the current findings, the BC+Exos membrane is a promising material to prevent postoperative epidural fibrosis and adhesion.
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Affiliation(s)
- Bo Wang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China, ,
| | - Peng Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China, ,
| | - Lei Shangguan
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China,
| | - Jun Ma
- Department of Orthopedics Trauma Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Kezheng Mao
- Department of Orthopedics, Orthopedics Hospital of Zhengzhou City, Zhengzhou, Henan, 450052, China
| | - Quan Zhang
- Department of Orthopedics, People's Hospital of Tianjin City, Tianjin, 300121, China
| | - Yiguo Wang
- Department of Orthopedics, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210000, China
| | - Zhongyang Liu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China, , .,Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China,
| | - Keya Mao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China, ,
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Bozkurt H, Bozkurt EC, Ozpinar H, Arac D, Kaya I, Ozer H, Egilmez R. Comparison of the Effects of Contractubex Gel and Benzothiazole After Topical Application in an Experimental Model of Epidural Fibrosis in Rats. World Neurosurg 2018; 117:e403-e410. [DOI: 10.1016/j.wneu.2018.06.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
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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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Tatar S, Sarybaeva A, Fındıkcıoğlu K, Seymen CM, Elmas Ç, Latifoğlu O. The Effect of Hyaluronic Acid Application on the Perisilicon Capsule Structure. Aesthetic Plast Surg 2016; 40:938-946. [PMID: 27766403 DOI: 10.1007/s00266-016-0718-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 10/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Silicon implants constitute a major part of plastic surgery practice. Although materials with high biocompatibility have been used around the implants, capsule formation still develops and progressive nature of this process results in capsule contraction. The aim of this study is to evaluate the effects of hyaluronic acid injected around the silicon block on the capsule structure. METHODS Twenty Wistar albino rats were used in the study. Rats were divided into two main groups (group 1 and group 2) and two subgroups. Rats in group 1 were sacrificed in week 4 and rats in group 2 were sacrificed in week 8. A subcutaneous pouch was created in the dorsum of the rats and a silicon block was placed into the pouch in groups 1A and 2A. 0.2 ml of hyaluronic acid was injected around the silicon block in group 1B and group 2B. Rats were sacrificed and capsule structure and thickness were analyzed following macroscopic evaluation. Concentrations of transforming growth factor-β1 (TGF-β1) and heat shock protein-47 (HSP-47) were evaluated immunohistochemically, and statistical comparisons were made. RESULT Capsule structure consisted of three layers in all the groups. A more intense collagen structure was observed in the middle layer. The capsule was thinnest in group 1A and thickest in group 2B; the difference between the groups was statistically significant. TGF-β1 was most intense in group 2B and it was correlated with the amount of collagen. Involvement of HSP-47 was observed mainly in collagen and also in fibroblasts and vascular structures, and its concentration was found to be lower in groups 2A and 2B. CONCLUSION Exogenously added cross-linked hyaluronic acid increased the capsular thickness and may increase the risk of developing capsular contracture around silicone implants. LEVEL OF EVIDENCE II Evidence was obtained from the well-designed controlled trials without randomization.
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Affiliation(s)
- Sedat Tatar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kayseri Research and Training Hospital, Kayseri, Turkey.
| | - Ainura Sarybaeva
- Department of Plastic Reconstructive and Aesthetic Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kemal Fındıkcıoğlu
- Department of Plastic Reconstructive and Aesthetic Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cemile Merve Seymen
- Department of Histology and Embriology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Çiğdem Elmas
- Department of Histology and Embriology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Osman Latifoğlu
- Department of Plastic Reconstructive and Aesthetic Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
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Larionov SN, Sorokovikov V, Erdyneyev K, Lepekhova S, Goldberg O. Experimental Model of Intervertebral Disk Mediated Postoperative Epidural Fibrosis. Ann Neurosci 2016; 23:76-80. [PMID: 27647957 PMCID: PMC5020382 DOI: 10.1159/000443564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 10/23/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Postoperative epidural fibrosis (EF) after lumbar discectomy is the most common and at the same time controversial issue. PURPOSE The etiology and pathogenesis creates a lot of discussion and selection of methods of treatment and prevention continues. METHODS LIV laminectomy with dura mater (DM) exposition was done in 24 rats, and then, 0.3 ml of elements of suspension of autologous intervertebral disk was implicated on DM. As autologous intervertebral disk, we used the intervertebral disk from amputated tail. In all the animals, incisions were closed with 3/0 Vicryl. EF was examined. Fibroblast cell density was calculated in each field at ×40 magnification: Grade 1 - fewer than 100 fibroblasts in each field; Grade 2 - 100-150 fibroblasts in each field; Grade 3 - more than 150 fibroblasts in each field. RESULTS Based on histological results, we confirmed our model of experiment. On the 30th day of evaluation, there were significant histological evidences of postoperative epidural adhesions in experimental animals, which included the obliteration of epidural space, the presence of adhesions in the dura and nerve roots, the restructuring of the yellow ligament, bone sclerosis, excessive appearance of fibrous tissue around the autologous intervertebral disk tissue that applied on the DM. CONCLUSION In our work, we describe a new experimental model, where the elements of autologous intervertebral disk play the role of inflammation trigger, which cause postoperative scar and EF.
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Affiliation(s)
- Sergey N. Larionov
- Scientific Center of Reconstructive and Restorative Surgery, RAMS, Siberian Branch, Irkutsk, Russia
- Department of Traumatology, Orthopedics and Neurosurgery, Irkutsk State Medical Academy of Continuous Education, Irkutsk, Russia
- Department of Child's Neurosurgery, A.L. Polenov Russian Neurosurgery Research Institute, Saint Petersburg, Russia
| | - V.A. Sorokovikov
- Scientific Center of Reconstructive and Restorative Surgery, RAMS, Siberian Branch, Irkutsk, Russia
- Department of Traumatology, Orthopedics and Neurosurgery, Irkutsk State Medical Academy of Continuous Education, Irkutsk, Russia
| | - K.C. Erdyneyev
- Scientific Center of Reconstructive and Restorative Surgery, RAMS, Siberian Branch, Irkutsk, Russia
| | - S.A. Lepekhova
- Scientific Center of Reconstructive and Restorative Surgery, RAMS, Siberian Branch, Irkutsk, Russia
| | - O.A. Goldberg
- Scientific Center of Reconstructive and Restorative Surgery, RAMS, Siberian Branch, Irkutsk, Russia
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Luo L, Zhang C, Zhao J, Wei Q, Li X. Effects of rapamycin on reduction of peridural fibrosis: an experimental study. Med Sci Monit 2015; 21:482-8. [PMID: 25677111 PMCID: PMC4335565 DOI: 10.12659/msm.893165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Peridural fibrosis (PF) is a normal complication after lumbar surgery. It is a challenge for both surgeons and patients. Rapamycin (RPM), a novel antibiotic with anti-proliferative and immunosuppressive properties, has been shown to be effective in preventing uncontrolled scar proliferation diseases. The object of the present research was to investigate the effects of RPM on inhibiting PF in vitro and in vivo. Material/Methods In vitro, the fibroblasts collected and isolated from the rat tail skin were cultured with/without RPM and cell counting was performed. In vivo, the double-blinded study was conducted in 60 healthy Wistar rats divided randomly into 3 groups: 1) RPM treatment group; 2) Vehicle treatment group; 3) Control group. Rats underwent a L1-L2 level laminectomy with a satisfactory anesthetization. Four weeks post-operatively, the Rydell score, histological analysis, hydroxyproline content, vimentin expressional level, and inflammatory cytokines expressional levels were assessed. Results In vitro, RPM showed ability to prevent fibroblast proliferation. In vivo, the laminectomy was well tolerated by all rats, which were killed 4 weeks post-operatively. The Rydell score, histological evaluation, hydroxyproline content, vimentin expression level, and inflammatory activity showed the positive effect of RPM in preventing peridural adhesion, inhibiting fibrotic formation and collagen synthesis, and down-regulating inflammation. Conclusions In the present primary study, RPM showed good efficacy in preventing the proliferation of fibroblasts. RPM can prevent rat peridural adhesion through inhibiting collagen synthesis, fibroblasts proliferation, and inflammatory activity.
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Affiliation(s)
- Like Luo
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Chifei Zhang
- Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Jinmin Zhao
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Qingjun Wei
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xiaofeng Li
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
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