scholarly journals Temperature-sensitive hydrogel loaded with DNase I alleviates epidural fibrosis in a mouse model of laminectomy

2022 ◽  
Vol 14 (1) ◽  
Author(s):  
Jinpeng Sun ◽  
Gang Wang ◽  
Haoran Wang ◽  
Feng Hua ◽  
Zeyuan Song ◽  
...  
Keyword(s):  
Mouse Model ◽  
Failed Back Surgery Syndrome ◽  
Dnase I ◽  
Gelatin Sponge ◽  
Temperature Sensitive ◽  
Epidural Fibrosis ◽  
Failed Back Surgery ◽  
Human Body Temperature ◽  
Dna Backbone

AbstractExcessive epidural fibrosis attached to the dura mater is the major cause of recurrent failed back surgery syndrome after spine surgery. Neutrophil extracellular traps (NETs) promote epidural fibrosis, raising the possibility that the DNA backbone of NETs may be a potential target in the therapy of epidural fibrosis. Human body temperature-sensitive hydroxypropyl chitin hydrogel solutions were prepared to encapsulate DNase I, which gradually decomposed in vivo. DNase I, which was released from temperature-sensitive hydrogels, destroyed the DNA backbone of NETs and dispersed the clustering of myeloperoxidase (MPO) in NETs. Evidence from MRI, H&E and Masson staining supported that hydroxypropyl chitin hydrogels loaded with DNase I were nontoxic and reduced epidural fibrosis. As expected, fibronectin in the wound was significantly abridged in the mice treated with hydrogels loaded with DNase I. Compared with the gelatin sponge absorbing DNase I, temperature-sensitive hydroxypropyl chitin hydrogels loaded with DNase I were more powerful in the therapy of epidural fibrosis. These results indicate that temperature-sensitive hydroxypropyl chitin hydrogels were effective in DNase I encapsulation and alleviation of epidural fibrosis in a mouse model of laminectomy.

scholarly journals Effect of Cerebrospinal Fluid on Fibroblasts Concerning Epidural Fibrosis: An In Vitro Study

2021 ◽  
Vol 5 (3) ◽  
pp. 100-108
Author(s):  
Doğa Gürkanlar ◽  
Sevda Lafcı Fahrioğlu ◽  
Umut Fahrioğlu
Keyword(s):  
Wound Healing ◽  
Skin Fibroblast ◽  
Lumbar Disc ◽  
Failed Back Surgery Syndrome ◽  
Epidural Fibrosis ◽  
Fibroblast Proliferation ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract One of the most common treatments for lumbar disc herniation and other lumbar disorders is lumbar laminectomy. There may be some unwanted and serious complications with this procedure such as the “failed back surgery syndrome (FBSS)”. Epidural fibrosis (EF), mainly due to fibroblast proliferation, emerges as the main cause of failed back surgery syndrome. According to the current literature and practice techniques, different agents are being used to prevent EF formation. To date there is no single agreed upon treatment method of EF. In this study, dilutional effect of CSF, together with low potassium levels, on primary skin fibroblast cultures was studied as a possible material for EF prevention. CSF at different concentrations (0-100%) were tested to see its effect on Skin fibroblast proliferation. A wound healing assay was also performed to see the effect of CSF on wound healing. The cell proliferation goes up from 24h to 72hr in all CSF percentages from 0-75% but the proliferation was inhibited at 100% CSF. The “wound” is closed successfully in all CSF percentages between 0-75. The 100% CSF fails to completely close the wound. Adverse effects of low concentrations of potassium levels and dilutional effect of CSF may be a promising solution in the prevention of EF. Further in vivo and in vitro experiments are required to characterize its use.

Mitomycin C in preventing spinal epidural fibrosis in a laminectomy model in rats

2004 ◽  
Vol 100 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Jin-Yul Lee ◽  
Werner Stenzel ◽  
Heinrich Ebel ◽  
Christoph Wedekind ◽  
Ralf-Ingo Ernestus ◽  
...  
Keyword(s):  
Mitomycin C ◽  
Spinal Column ◽  
Failed Back Surgery Syndrome ◽  
Epidural Fibrosis ◽  
En Bloc ◽  
Content Type ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Spinal Epidural ◽  
Fine Print

Object. Extensive epidural fibrosis after lumbar surgery may be the underlying cause in most cases of failed—back surgery syndrome. Various materials have been used to prevent epidural fibrosis, but only moderate success has been shown. Mitomycin C, an alkylosing antibiotic substance isolated from Streptomyces caespitosus, potentially supresses fibroblast proliferation after surgery. In this study, the authors investigated the effect of mitomycin C by local application on spinal epidural fibrosis in a rat laminectomy model. Methods. Five Wistar rats underwent laminectomy at cervical, thoracic, and lumbar levels. Based on data obtained from ophthalmological studies, mitomycin C was applied to the laminectomy sites in various concentrations (0.01, 0.05, and 0.1 mg/ml). One laminectomy site in each rat was left untreated and thus served as a control. Evoked potentials were measured pre- and postoperatively, and all rats underwent clinical evaluation. Mobility status and evidence of neurological deficit were recorded. Twelve weeks later, the rats were killed, and the spinal column, including surrounding muscle tissue, was removed en bloc, decalcified, and fixed in formaldehyde. Epidural fibrosis was evaluated histologically. In all mitomycin C—treated laminectomy sites, epidural scarring was significantly reduced compared with control sites. Remarkably, dural adhesions were absent in laminectomy defects treated with mitomycin C concentrations of 0.05 and 0.1 mg/ml. Moderate to marked epidural fibrosis with adhesion to the dura mater was noted at sites receiving 0.01 mg/ml of mitomycin C. All control sites showed dense epidural fibrosis with marked dura adherence. Conclusions. In this experimental model, mitomycin C applied locally at a concentration of 0.1 mg/ml effectively reduced epidural fibrosis, completely avoided dural adherence, and induced no side effects.

scholarly journals Neuromodulation in the Treatment of Postoperative Epidural Fibrosis: Comparison of the Extent of Epidural Fibrosis and the Effect of Stimulation

2021 ◽  
pp. 461-468
Author(s):  
V MASOPUST ◽  
J HOLUBOVÁ ◽  
P SKALICKÝ ◽  
R ROKYTA ◽  
J FRICOVÁ ◽  
...  
Keyword(s):  
Failed Back Surgery Syndrome ◽  
Dorsal Column ◽  
Implantation Technique ◽  
Epidural Fibrosis ◽  
Study Objective ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Lumbar Spinal ◽  
Dorsal Column Stimulation ◽  
Group 1

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 ΔVAS after our division into Group 0 was 4.82; for Group 1 it was 6.13. Evaluation of EF and ΔVAS 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 postope-rative 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.

scholarly journals Celecoxib-Loaded Electrospun Fibrous Antiadhesion Membranes Reduce COX-2/PGE2 Induced Inflammation and Epidural Fibrosis in a Rat Failed Back Surgery Syndrome Model

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Wei Wang ◽  
Yunhao Wang ◽  
Tengfei Lou ◽  
Mingqian Ding ◽  
Juehong Li ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Surgery ◽  
Failed Back Surgery Syndrome ◽  
Surgical Trauma ◽  
Epidural Fibrosis ◽  
Resonance Imaging ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Cox 2 ◽  
Fibrous Membranes

To date, failed back surgery syndrome (FBSS) remains a therapy-refractory clinical condition after spinal surgery. The antiadhesion membrane is applied to prevent FBSS by isolating fibrosis; however, the inflammation stimulated by the foreign body and surgical trauma needs to be further resolved simultaneously. Therefore, we developed new electrospun polycaprolactone (PCL) fibrous membranes loaded with celecoxib (CEL) to prevent fibrosis and inflammation associated with FBSS. The CEL-loaded PCL fibers were randomly distributed, and the drug was released over two weeks. Fluorescence micrographs revealed that the fibroblasts proliferated less on the PCL-CEL fibrous membranes than in the PCL group and the blank control. In the rat laminectomy model after 4 weeks, magnetic resonance imaging of epidural fibrosis was least in the PCL-CEL group. Expression of COX-2 and PGE2 was lower in the PCL-CEL group. It concluded that the CEL-loaded PCL membrane could reduce fibrosis and inflammation in a rat model of FBSS via COX-2/PGE2 signaling pathways.

scholarly journals Systematic Review of Percutaneous Adhesiolysis and Management of Chronic Low Back Pain in Post Lumbar Surgery Syndrome

2009 ◽  
Vol 2;12 (2;3) ◽  
pp. 361-378 ◽  
Author(s):  
Richard Epter
Keyword(s):  
Chronic Low Back Pain ◽  
Observational Studies ◽  
Randomized Trials ◽  
Failed Back Surgery Syndrome ◽  
Epidural Fibrosis ◽  
Low Back ◽  
Lumbar Surgery ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Level I

Background: Post lumbar surgery syndrome or failed back surgery syndrome with persistent pain continues to increase over the years. The speculated causes of post lumbar laminectomy syndrome include acquired stenosis, epidural fibrosis, arachnoiditis, radiculopathy, and recurrent disc herniation. Epidural fibrosis may account for as much as 20% to 36% of all cases of failed back surgery syndrome. Percutaneous epidural adhesiolysis has been employed in interventional pain management in the treatment of chronic, refractory low back and lower extremity pain after back surgery. Study Design: A systematic review of randomized trials and observational studies. Objective: To evaluate the effectiveness of percutaneous adhesiolysis in managing chronic low back and lower extremity pain due to post lumbar surgery syndrome. Methods: A comprehensive literature search was conducted utilizing electronic databases, as well as systematic reviews and cross references from 1966 through December 2008. The quality of individual articles used in this analysis was assessed by modified Cochrane review criteria for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for assessment of observational studies. Clinical relevance was evaluated using 5 questions according to the criteria recommended by the Cochrane Review Back Group. Analysis was conducted using 5 levels of evidence, ranging from Level I to III, with 3 subcategories in Level II. Outcome Parameters: The primary outcome measure was pain relief (short-term relief of at least 6 months and long-term relief of more than 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and change in opioid intake. Results: Of the 13 studies considered for inclusion, 3 randomized trials and 4 observational studies met the inclusion criteria for methodologic quality assessment and evidence synthesis based on methodologic quality scores of 50 or more. Evidence of percutaneous adhesiolysis in the management of chronic low back pain in post-lumbar surgery syndrome is Level I to Level II1, with evidence derived from 3 randomized trials. Limitations: There is a paucity of efficacy and pragmatic trials. No trials have been published after 2006. Conclusion: The indicated level of evidence for percutaneous adhesiolysis is Level I or II-1 based on the US Preventative Services Task Force (USPSTF) criteria. Key words: Chronic low back pain, post lumbar surgery syndrome, post surgery syndrome, failed back surgery syndrome, spinal stenosis, epidural fibrosis, interventional techniques, percutaneous adhesiolysis, hypertonic saline neurolysis

A tranilast and BMP-2 based functional bilayer membrane is effective for the prevention of epidural fibrosis during spinal lamina reconstruction

2019 ◽  
Vol 7 (19) ◽  
pp. 3075-3087
Author(s):  
Chen Han ◽  
Xunlin Li ◽  
Tangjun Zhou ◽  
Chen Chen ◽  
Kai Zhang ◽  
...  
Keyword(s):  
Failed Back Surgery Syndrome ◽  
Bilayer Membrane ◽  
Epidural Fibrosis ◽  
Lumbar Surgery ◽  
Common Complication ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Spinal Lamina

Failed Back Surgery Syndrome (FBSS) is a common complication of lumbar surgery.

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