A New Material for Prevention of Epidural Fibrosis After Laminectomy (original) (raw)
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Update on biomaterials for prevention of epidural adhesion after lumbar laminectomy
Journal of orthopaedic translation, 2018
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...
2018
The aim of this study was to evaluate of the effect of 5% Polyethylene Glycol 4000 in the prevention of epidural fibrosis and to compare the results with hyaluronic acid. A total of 36 adult New Zealand White Rabbits were used in the study. Three groups were formed with each group including 12 rabbits (Group I: Control, Group II: 5% Polyethylene Glycol 4000, Group III: Hyaluronic acid). Hemilaminectomy was performed at L5 vertebrae on the right side. Three rabbits randomly selected from each group at postoperative 2nd, 4th, 8th and 12th week were euthanized. Macroscopic and histopathological evaluation were performed in terms of the amount of scar tissues. Statistical evaluation was made with Mann-Whitney U Test and Kruskal-Wallis Variance Analysis. P < 0.05 was considered statistically significant. In the hemilaminectomy sites of Group I, severe thickness and tenacious epidural scar adhesions were found between the dura mater and surrounding tissues. In the Group II, dura mater ...
TURKISH JOURNAL OF MEDICAL SCIENCES, 2021
Background/aim: To investigate the histopathological effects of reabsorbable polyethylene glycol hydrogel (RPGH, Coseal) on epidural fibrosis (EF) following laminectomy in rats. Materials and methods: A total of 24 rats were equally divided into three groups. In the first group, no treatment was applied after laminectomy (control group, Group 1). In the second group, hemostasis was achieved after laminectomy, and 2 mm absorbable gelatin sponge soaked in saline was placed over the epidural space and the wound was closed (Group 2). In the third group, hemostasis was achieved following laminectomy, and 0.5 mL RPGH (Coseal, Group 3) was squeezed over the dura mater, and the wound was closed. A histopathological examination was undertaken to evaluate arachnoidal invasion and EF. Results: The results of EF in the Group 2 and Group 3 were significantly lower compared to the Group 1 (p = 0.023 and p = 0.002, respectively). No statistically significant difference was found between the Group 2 and Group 3 in terms of EF (p = 0.957). There was also no statistically significant difference between the mean arachnoidal invasion of the three groups (p > 0.171). However, the rate of arachnoidal invasion was the lowest in the Group 3. Conclusion: Intraoperative Coseal, a polyethylene glycol polymer, tends to reduce the risk of epidural fibrosis, although this is not statistically significant.
The Spine Journal, 2014
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 (p5.024) and microscopically (p5.041). 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. Ó
Effectiveness of the Biophysical Barriers to the Peridural Fibrosis in Rat Laminectomy Model
Journal of Investigative Surgery, 2018
Purpose: Peridural fibrosis which could occur after the spinal surgery could adhere neural tissue closely and may cause to neural entrapment symptoms and require surgical reintervention. Aim of the study: Present study was designed to reduce occurrence of peridural fibrosis in rat laminectomy model by using biophysical barriers called hyaluronic acid (HAS) dural barrier, activated polyethylene glycol and polyethylene imine (PEG) dural barrier, and platelet-rich plasma (PRP). Materials and methods: In this study, 2 of 26 male Wistar albino rats (325-350 g body weight), which were not included into study groups were sacrificed by removing their total blood and their blood was used for preparation of PRP, and remaining rats were randomly delivered into four groups called SHAM, HAS, PEG, and PRP groups. Then L3-4-5 laminectomy was performed to all animals and experimental agents were administered to the selected groups mentioned above. Spinal colons of all animals were removed gross total after 6-week period and investigated histopathologically. Additionally, real-time-polymerase chain reaction was used to obtain collagen type I and type III, transforming growth factor-1β, and tumor necrosis factor-α gene expressions. Results: All results demonstrated that polyethylene glycol and polyethylene imine dural barrier and PRP could decrease peridural fibrosis formation efficiently in rat. Conclusion: Present study results suggested that to reduce or block formation of peridural fibrosis, either polyethylene glycol and polyethylene imine dural barrier or PRP could be used effectively in human subjects after they will be closely investigated in future studies.
Hemostasis vs. epidural fibrosis?: A comparative study on an experimental rat model of laminectomy
Neurologia i Neurochirurgia Polska, 2016
The aim of this study was to evaluate the histopathological and biochemical impact and effectiveness of two hemostatic agents, Ankaferd blood stopper (ABS) and Microporous Polysaccharide Hemospheres (MPH), on epidural fibrosis in an experimental rat laminectomy model. Material and methods: Twenty adult Wistar albino rats were divided into MPH-treated (n = 6), ABS-treated (n = 6) and control (n = 8) groups. Laminectomy of the lumbar spine was performed in all animals and treatment groups were exposed to MPH and ABS while closure was applied in control group as per usual. Epidural fibrosis was evaluated in all groups macroscopically, histopathologically, biochemically and with electron microscopy four weeks later. Results: Statistically, it was found that MPH-treated group had significantly less epidural fibrosis compared to ABS-treated and control groups. Conclusion: We compared two hemostatic agents for their propensity to cause adhesions in the present study. Our results show that MPH significantly reduces epidural scar formation and dural adhesion in a rat model of laminectomy while ABS increases postoperative fibrosis.
European cells & materials, 2017
Post-operative epidural fibrosis is a biological response after laminectomy that may lead to clinical symptoms, such as radicular pain. An ideal material for prevention of epidural fibrosis should be able to inhibit fibroblast adhesions and reduce formation of scar tissue. An injectable hydrogel would be the material of choice for this purpose, since it could fill an irregular surgical defect completely, gelate in situ and be delivered in a minimally-invasive manner. The objective of this study was to evaluate, in vitro and in vivo, the cytocompatibility and anti-adhesive effect of an oxidised hyaluronic acid/adipic acid dihydrazide (oxi-HA/ADH) hydrogel. Different cell types present in the spine were used to test the cytocompatibility of the hydrogel. The hydrogel extraction medium had no deleterious effects on neural cells (PC-12), but reduced fibroblasts viability (NIH/3T3). Although the hydrogel did not change the release of lactate dehydrogenase from myoblasts (C2C12) and Schwa...
Muğla Sıtkı Koçman üniversitesi tıp dergisi/Muğla Sıtkı Koçman Üniversitesi tıp dergisi :, 2024
Dural grafts are sometimes necessary for repairing spinal dural defects. The search for an ideal material for duraplasty remains a controversial topic. Twenty-six adult male Wistar-Albino rats, weighing 260-380 g, were used. The rats were divided into three groups: Control (n=10), Fascia (n=6), and Gore-Tex (polytetrafluoroethylene) Surgical Membrane group (n=10). After laminectomy was performed on the rats, a dural defect was created. Then, one of the procedures 'leaving the defect open,' 'duraplasty with fascia,' and 'duraplasty with Gore-Tex surgical membrane' was performed. On the 60th day after surgery, the rats were euthanized, and histological investigations were conducted to examine the granulation tissue and adhesions in the operative area. It was observed that granulation tissue filled the defect area in all three groups. In the fascia group, it was observed that the fascia formed a barrier between the dura mater and neural tissue and the granulation tissue, but it was filled with dense granulation tissue and there was adhesion. It was found that the granulation tissue did not adhere to the Gore-Tex surgical membrane in the Gore-Tex surgical membrane group, and the Gore-Tex surgical membrane created an excellent physical barrier preventing adhesion between the dura mater and neural and the granulation tissues.