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.

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

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 Factors Predicting the Success of Adhesiolysis Using a Steerable Catheter in Lumbar Failed Back Surgery Syndrome: A Retrospective Study

2021 ◽  
Vol 10 (5) ◽  
pp. 913
Author(s):  
Ji Yeong Kim ◽  
Yong Ho Lee ◽  
Subin Yoo ◽  
Ji Young Kim ◽  
Mina Joo ◽  
...  
Keyword(s):  
Poor Response ◽  
Failed Back Surgery Syndrome ◽  
Foraminal Stenosis ◽  
Outer Diameter ◽  
Lumbar Surgery ◽  
First Line ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Reasonable Evidence ◽  
Reduction Effect

Failed back surgery syndrome (FBSS) is a commonly encountered disease after lumbar surgery. There are many cases where it is difficult to choose a treatment because no specific cause can be found. Nevertheless, according to recent reports, adhesiolysis has shown reasonable evidence. However, considering its poor cost-effectiveness, adhesiolysis cannot be used as the first line of treatment. FBSS patients often suffer from chronic pain; accordingly, they become frustrated when this treatment produces a poor response. Therefore, before the procedure, the target group must be selected carefully. We sought to identify the pre-procedure factors predicting the effect of adhesiolysis in FBSS. A total of 150 patients were evaluated and analyzed retrospectively. Of these 150 patients, 69 were classified as responders three months after the procedure (46%). The outer diameter of the catheter during the procedure and grade of foraminal stenosis were correlated with the procedure effect. In conclusion, of the 2.1 mm diameter of the catheter, 1.7 mm of it was used during the procedure, and the milder the foraminal stenosis, the greater the pain reduction effect was three months after the procedure.

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 Retinal Hemorrhage after Epiduroscopy in a Patient using Dexamethasone: A Case Report

2019 ◽  
pp. 33-36
Author(s):  
JanWillem Kallewaard
Keyword(s):  
Case Report ◽  
Epidural Space ◽  
Retinal Hemorrhage ◽  
Failed Back Surgery Syndrome ◽  
Epidural Fibrosis ◽  
Retinal Hemorrhages ◽  
First Case ◽  
Short Period ◽  
Failed Back Surgery ◽  
Back Surgery

Epiduroscopy is a minimally invasive procedure used to diagnose epidural fibrosis and to release this fibrosis; epiduroscopy is also used to precisely deposit medication into the epidural space. It is commonly used in patients who are diagnosed with failed back surgery syndrome (FBSS) after more conservative treatment has failed to provide sufficient relief of symptoms. A rare complication of epiduroscopy is retinal hemorrhaging, which is likely caused by overpressurization of the epidural space during the procedure. Patient-related risk factors for developing retinal hemorrhage after epiduroscopy remain largely unknown. This is the first case report of retinal hemorrhage in a patient using chronic dexamethasone. We describe a 73-year-old man diagnosed with FBSS who underwent epiduroscopy to diagnose and relieve epidural fibrosis. The procedure was uneventful and he was discharged from our clinic the same day, but upon routine check-up he mentioned blurry vision. Immediately he was referred to an ophthalmologist who diagnosed retinal hemorrhages in both eyes upon fundoscopic examination. Our patient was using dexamethasone for the treatment of allergies. Three months after the procedure, his vision was restored fully in the right eye and 95% in the left eye. Chronic corticosteroid use may weaken retinal veins, making them prone to rupture when there is increased pressure, even for a short period of time. Chronic use of corticosteroids must be considered a risk factor for developing retinal hemorrhages in patients undergoing epiduroscopy. Long-term use of corticosteroid can be considered as a relative contraindication for epiduroscopy. Key words: Epiduroscopy, complications, interventional pain, corticosteroids, retinal hemmorhage, failed back surgery syndrome

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