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Lewik G, Lewik G, Müller LS, von Glinski A, Schulte TL, Lange T. Postoperative Epidural Fibrosis: Challenges and Opportunities - A Review. Spine Surg Relat Res 2024; 8:133-142. [PMID: 38618214 PMCID: PMC11007250 DOI: 10.22603/ssrr.2023-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 04/16/2024] Open
Abstract
Postoperative epidural fibrosis (EF) is still a major limitation to the success of spine surgery. Fibrotic adhesions in the epidural space, initiated via local trauma and inflammation, can induce difficult-to-treat pain and constitute the main cause of failed back surgery syndrome, which not uncommonly requires operative revision. Manifold agents and methods have been tested for EF relief in order to mitigate this longstanding health burden and its socioeconomic consequences. Although several promising strategies could be identified, few have thus far overcome the high translational hurdle, and there has been little change in standard clinical practice. Nonetheless, notable research progress in the field has put new exciting avenues on the horizon. In this review, we outline the etiology and pathogenesis of EF, portray its clinical and surgical presentation, and critically appraise current efforts and novel approaches toward enhanced prevention and treatment.
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Affiliation(s)
- Guido Lewik
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Gerrit Lewik
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Lena S Müller
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Alexander von Glinski
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Tobias L Schulte
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Tobias Lange
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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Neuroimmune crosstalk in the cornea: The role of immune cells in corneal nerve maintenance during homeostasis and inflammation. Prog Retin Eye Res 2022; 91:101105. [PMID: 35868985 DOI: 10.1016/j.preteyeres.2022.101105] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 12/29/2022]
Abstract
In the cornea, resident immune cells are in close proximity to sensory nerves, consistent with their important roles in the maintenance of nerves in both homeostasis and inflammation. Using in vivo confocal microscopy in humans, and ex vivo immunostaining and fluorescent reporter mice to visualize corneal sensory nerves and immune cells, remarkable progress has been made to advance our understanding of the physical and functional interactions between corneal nerves and immune cells. In this review, we summarize and discuss recent studies relating to corneal immune cells and sensory nerves, and their interactions in health and disease. In particular, we consider how disrupted corneal nerve axons can induce immune cell activity, including in dendritic cells, macrophages and other infiltrating cells, directly and/or indirectly by releasing neuropeptides such as substance P and calcitonin gene-related peptide. We summarize growing evidence that the role of corneal intraepithelial immune cells is likely different in corneal wound healing versus other inflammatory-dominated conditions. The role of different types of macrophages is also discussed, including how stromal macrophages with anti-inflammatory phenotypes communicate with corneal nerves to provide neuroprotection, while macrophages with pro-inflammatory phenotypes, along with other infiltrating cells including neutrophils and CD4+ T cells, can be inhibitory to corneal re-innervation. Finally, this review considers the bidirectional interactions between corneal immune cells and corneal nerves, and how leveraging this interaction could represent a potential therapeutic approach for corneal neuropathy.
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Fayed M, Angappan S, Oyibo O, Valliani A. Role of Imaging Studies in Evaluating Patients Post Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Cureus 2021; 13:e20601. [PMID: 35103177 PMCID: PMC8782632 DOI: 10.7759/cureus.20601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 12/28/2022] Open
Abstract
A 77-year-old male presented to the ED with a new onset of acute abdominal pain, nausea, and vomiting. He had a previous surgical history of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for an appendiceal tumor. Despite the repeated reassuring abdominal examinations, CT abdomen showed high-grade bowel obstruction and perforation. He was urgently taken to the operating room and underwent resection of 70 cm segment of small ischemic bowel with primary anastomosis. His postoperative course was complicated with atrial fibrillation (AF) requiring cardioversion and medical therapy. Later, he was discharged home under stable conditions. Relying on abdominal signs, an abdominal exam in a patient with a previous history of extensive peritonectomy and post-HIPEC surgery is challenging due to the altered peritoneal anatomy. As a result, the abdominal examination findings can be benign and misleading. This can lead to delayed surgical intervention, thereby increasing morbidity and mortality significantly. Therefore, a detailed evaluation with a low threshold for abdominal imaging studies like abdominal X-rays and CT abdomen series is warranted in this subset of patients.
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Messaoudi O, Wink J, Bendahou M. Diversity of Actinobacteria Isolated from Date Palms Rhizosphere and Saline Environments: Isolation, Identification and Biological Activity Evaluation. Microorganisms 2020; 8:E1853. [PMID: 33255541 PMCID: PMC7760371 DOI: 10.3390/microorganisms8121853] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/20/2023] Open
Abstract
The diversity of cultural Actinobacteria in two types of Algerian Sahara environments, including saline environments and date palms rhizosphere, was investigated. In this study, a total of 40 strains of actinomycetes was isolated from different soil samples, using a rehydration and centrifugation method. Molecular identification, based on 16S rRNA gene sequence analysis, revealed that these isolates were affiliated to six clusters corresponding to eight genera, including Streptomyces, Nocardiopsis, Saccharopolyspora, Actinomadura, Actinocorallia, Micromonospora, Couchioplanes, and Planomonospora. A taxonomic analysis, based on the morphological, physiological, biochemical, and molecular investigation, of selected strains, which belong to the rare Actinobacteria, was undertaken. Four strains (CG3, A111, A93, and A79) were found to form distinct phyletic lines and represent new actinobacterial taxa. An assessment of antimicrobial proprieties of the 40 obtained actinomycetes strains, showed moderate to strong antimicrobial activities against fungi and bacteria. This study demonstrated the richness of Algerian Sahara with rare Actinobacteria, which can provide novel bioactive metabolites, to solving some of the most challenging problems of the day, such as multi-drug resistance.
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Affiliation(s)
- Omar Messaoudi
- Laboratory of Applied Microbiology in Food, Biomedical and Environment, Abou Bekr Belkaïd University, 13000 Tlemcen, Algeria;
- Department of Biology, Faculty of Science, University of Amar Telidji, 03000 Laghouat, Algeria
- Microbial Strain Collection, Helmholtz Centre for Infection Research GmbH (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany;
| | - Joachim Wink
- Microbial Strain Collection, Helmholtz Centre for Infection Research GmbH (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany;
| | - Mourad Bendahou
- Laboratory of Applied Microbiology in Food, Biomedical and Environment, Abou Bekr Belkaïd University, 13000 Tlemcen, Algeria;
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Medeiros CS, Santhiago MR. Corneal nerves anatomy, function, injury and regeneration. Exp Eye Res 2020; 200:108243. [PMID: 32926895 DOI: 10.1016/j.exer.2020.108243] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/29/2022]
Abstract
The cornea is a highly innervated tissue, exhibiting a complex nerve architecture, distribution, and structural organization. Significant contributions over the years have allowed us to come to the current understanding about the corneal nerves. Mechanical or chemical trauma, infections, surgical wounds, ocular or systemic comorbidities, can induce corneal neuroplastic changes. Consequently, a cascade of events involving the corneal wound healing, trophic functions, neural circuits, and the lacrimal products may interfere in the corneal homeostasis. Nerve physiology drew the attention of investigators due to the popularization of modern laser refractive surgery and the perception of the destructive potential of the excimer laser to the corneal nerve population. Nerve fiber loss can lead to symptoms that may impact the patient's quality of life, and impair the best-corrected vision, leading to patient and physician dissatisfaction. Therefore, there is a need to better understand preoperative signs of corneal nerve dysfunction, the postoperative mechanisms of nerve degeneration and recovery, aiming to achieve the most efficient way of treating nerve disorders related to diseases and refractive surgery.
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Affiliation(s)
| | - Marcony R Santhiago
- University of São Paulo, São Paulo, SP, Brazil; University of Southern California, Los Angeles, CA, United States
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Medeiros CS, Marino GK, Lassance L, Thangavadivel S, Santhiago MR, Wilson SE. The Impact of Photorefractive Keratectomy and Mitomycin C on Corneal Nerves and Their Regeneration. J Refract Surg 2019; 34:790-798. [PMID: 30540361 DOI: 10.3928/1081597x-20181112-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/12/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine how photorefractive keratectomy (PRK) and mitomycin C (MMC) affect corneal nerves and their regeneration over time after surgery. METHODS Twenty-eight New Zealand rabbits had corneal epithelial scraping with (n = 3) and without (n = 3) MMC 0.02% or -9.00 diopter PRK with (n = 6) and without (n = 16) MMC 0.02%. Corneas were removed after death and corneal nerve morphology was evaluated using acetylcholinesterase immunohistochemistry and beta-III tubulin staining after 1 day for all groups, after 1 month for PRK with and without MMC, and 2, 3, and 6 months after PRK without MMC. Image-Pro software (Media Cybernetics, Rockville, MD) was used to quantitate the area of nerve loss after the procedures and, consequently, regeneration of the nerves over time. Opposite eyes were used as controls. RESULTS Epithelial scraping with MMC treatment did not show a statistically significant difference in nerve loss compared to epithelial scraping without MMC (P = .40). PRK with MMC was significantly different from PRK without MMC at 1 day after surgery (P = .0009) but not different at 1 month after surgery (P = .90). In the PRK without MMC group, nerves regenerated at 2 months (P < .0001) but did not return to the normal preoperative level of innervation until 3 months after surgery (P = .05). However, the morphology of the regenerating nerves was abnormal-with more tortuosity and aberrant innervation compared to the preoperative controls-even at 6 months after surgery. CONCLUSIONS PRK negatively impacts the corneal nerves, but they are partially regenerated by 3 months after surgery in rabbits. Nerve loss after PRK extended peripherally to the excimer laser ablated zone, indicating that there was retrograde degeneration of nerves after PRK. MMC had a small additive toxic effect on the corneal nerves when combined with PRK that was only significant prior to 1 month after surgery. [J Refract Surg. 2018;34(12):790-798.].
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Wang H, Sun W, Fu D, Shen Y, Chen YY, Wang LL. Update on biomaterials for prevention of epidural adhesion after lumbar laminectomy. J Orthop Translat 2018; 13:41-49. [PMID: 29662790 PMCID: PMC5892378 DOI: 10.1016/j.jot.2018.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 12/12/2022] Open
Abstract
Lumbar laminectomy often results in failed back surgery syndrome. Most scholars support the three-dimensional theory of adhesion: Fibrosis surrounding the epidural tissues is based on the injured sacrospinalis behind, fibrous rings and posterior longitudinal ligaments. Approaches including using the minimally invasive technique, drugs, biomaterial and nonbiomaterial barriers to prevent the postoperative epidural adhesion were intensively investigated. Nevertheless, the results are far from satisfactory. Our review is based on various implant biomaterials that are used in clinical applications or are under study. We show the advantages and disadvantages of each method. The summary will help us to figure out ideas towards new techniques. The translational potential of this article: This review summarises recent biomaterials-related clinical and basic research that focuses on prevention of epidural adhesion after lumbar laminectomy. We also propose a novel possible translational method where a soft scaffold acts as a physical barrier in the early stage, engineered adipose tissue acts as a biobarrier in the later stage in the application of biomaterials and adipose-derived mesenchymal stem cells are used for prevention of epidural adhesion.
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Affiliation(s)
- Huailan Wang
- Department of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Wenjia Sun
- Department of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Dongliang Fu
- Department of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Yueliang Shen
- Department of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Ying-Ying Chen
- Department of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Lin-Lin Wang
- Department of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310058, China
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Wang S, Li X, Yan L, Chen H, Wang J, Sun Y. Upregulation of P27 Kip1 by mitomycin C induces fibroblast apoptosis and reduces epidural fibrosis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:11779-11788. [PMID: 31966541 PMCID: PMC6966039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/21/2017] [Indexed: 06/10/2023]
Abstract
Fibroblast excessive proliferation is considered as one of the major reasons of epidural fibrosis after laminectomy. Recent studies have shown that mitomycin C (MMC) could successfully reduce the formation of epidural fibrosis by inducing fibroblasts apoptosis. However, the detailed mechanism was still unclear. Increasing evidence indicated that P27Kip1 (P27) could result in apoptotic cell death in various cells. In this study, we investigated whether MMC could induce fibroblasts apoptosis and reduce epidural fibrosis by regulating P27. Western blot analysis, Hoechst staining, Flow cytometry, and Cell Counting Kit-8 (CCK-8) assay were used to detect the effect of MMC on fibroblasts apoptosis by regulating P27 expression in vitro. Moreover, histological and immunohistochemical assays were used to evaluate the effect of MMC on reducing epidural fibrosis by regulating P27 expression in rats. The results showed that MMC could induce fibroblasts apoptosis and upregulate P27 expression in vitro. Knockdown of P27 partially attenuated MMC-induced expressions of P27 and cleaved PARP as well as increased the cell viability. MMC could reduce epidural fibrosis in a dose-dependent manner in rats by histological analysis. The expression of P27 was increased by MMC treatment as shown by immuohistochemical analysis. In conclusion, this study demonstrated that MMC could upregulate P27 expression, which subsequently induced fibroblasts apoptosis and reduced epidural fibrosis.
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Affiliation(s)
- Shuguang Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
| | - Xiaolei Li
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
| | - Lianqi Yan
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
| | - Hui Chen
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
| | - Jingcheng Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
| | - Yu Sun
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopedic Institute, Subei People's Hospital of Jiangsu Province Yangzhou 225001, China
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