Journal articles: 'Epidural adhesion'

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Zhivotenko, A. P., V. A. Sorokovikov, and Z. V. Koshkareva. "Formation of Adhesive Arachnoiditis with Epidural Fibrosis as a Cause of Repeated Surgical Interventions (Clinical Case)." Acta Biomedica Scientifica 5, no. 3 (July 13, 2020): 54–61. http://dx.doi.org/10.29413/abs.2020-5.3.8.

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The work presents a rare clinical case of adhesive arachnoiditis, which developed against the background of epidural fibrosis during repeated surgical interventions. The cicatricial adhesion in the epidural space is formed in 100% of cases after surgery and is a frequent cause of intraoperative complications during repeated surgical interventions (bleeding, damage to the spinal cord and the dura mater with subsequent outflow of cerebrospinal fluid) and, therefore, an unsatisfactory result of surgical treatment with the formation of constant pain of various intensity, pseudomeningocele, commissural arachnoiditis, etc. The cicatricial adhesion in the epidural space is the main reason for the development of failed back surgery syndrome (FBSS), which today is an important and unresolved problem in spinal surgery. The epidural, as well as the subdural and subarachnoid space of the operated spinal motor segment of the spinal canal can be involved in the cicatricial adhesion, as it is shown in our clinical example. In this regard, it is important to prevent the development of the cicatricial adhesion in the epidural space during primary spinal surgeries, since with the increase in life expectancy of the population and increase in surgical activity during spinal surgeries, the patient can be operated repeatedly. Consequently, the question arises of preventing the formation of the cicatricial adhesion in 100% of cases with each surgical intervention, since the formed cicatricial adhesion in the epidural space does not have effective methods of conservative and surgical treatment and worsens favorable and satisfactory forecasts of surgical treatment for repeated surgical interventions.

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Shin, Dong Ah. "Finite Element Analysis of the Effect of Epidural Adhesions." July 2016 5;19, no. 5;19 (July 14, 2016): E787—E793. http://dx.doi.org/10.36076/ppj/2016.19.e787.

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Background: It is well documented that epidural adhesion is associated with spinal pain. However, the underlying mechanism of spinal pain generation by epidural adhesion has not yet been elucidated. Objectives: To elucidate the underlying mechanism of spinal pain generation by epidural adhesion using a two-dimensional (2D) non-linear finite element (FE) analysis. Study design: A finite element analysis. Setting: A two-dimensional nonlinear FE model of the herniated lumbar disc on L4/5 with epidural adhesion. Methods: A two-dimensional nonlinear FE model of the lumbar spine was developed, consisting of intervertebral discs, dura, spinal nerve, and lamina. The annulus fibrosus and nucleus pulpous were modeled as hyperelastic using the Mooney-Rivlin equation. The FE mesh was generated and analyzed using Abaqus (ABAQUS 6.13.; Hibbitt, Karlsson & Sorenson, Inc., Providence, RI, USA). Epidural adhesion was simulated as rough contact, in which no slip occurred once two surfaces were in contact, between the dura mater and posterior annulus fibrosus. Results: The FE model of adhesion showed significant stress concentration in the spinal nerves, especially on the dorsal root ganglion (DRG). The stress concentration was caused by the lack of adaptive displacement between the dura mater and posterior annulus fibrosus. The peak von Mises stress was higher in the epidural adhesion model (Adhesion, 0.67 vs. Control, 0.46). In the control model, adaptive displacement was observed with decreased stress in the spinal nerve and DRG (with adhesion, 2.59 vs. without adhesion, 3.58, P < 0.00). Limitations: This study used a 2D non-linear FE model, which simplifies the 3D nature of the human intervertebral disc. In addition, this 2D non-linear FE model has not yet been validated. Conclusion: The current study clearly demonstrated that epidural adhesion causes significantly increased stress in the spinal nerves, especially at the DRG. We believe that the increased stress on the spinal nerve might elicit more pain under similar magnitudes of lumbar disc protrusion. Key words: Finite element, epidural adhesion, spinal pain, adhesiolysis

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Hyun, Dong-Min, Chan-Hye Park, Yujin Kim, and Seong-Soo Choi. "Successful electrode insertion for spinal cord stimulation after balloon adhesiolysis in a patient with epidural adhesion - A case report -." Anesthesia and Pain Medicine 16, no. 2 (April 30, 2021): 191–95. http://dx.doi.org/10.17085/apm.20084.

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Background: Spinal cord stimulation (SCS) can be successfully performed using highly developed implantation techniques. However, anatomical barriers, such as epidural adhesion, may impede placing the electrode for SCS in an adequate position.Case: A 60-year-old woman who had SCS with an electrode at the T9-10 level removed because she had a wound infection at the back incision site. After the wound infection was completely resolved, we tried to re-insert the SCS electrode. However, it was difficult to advance it up to the T11 level due to epidural adhesion. We performed a combined epidural adhesiolysis using balloon decompression with an inflatable balloon catheter. After that, the SCS lead was successfully placed up to the T11 level, and implantation of SCS was performed.Conclusions: When a patient has epidural adhesion, an epidural adhesiolysis with an inflatable balloon catheter may help the insertion of the SCS electrode in the epidural space.

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Welch, William C., Kevin A. Thomas, G. Bryan Cornwall, Peter C. Gerszten, Jeffrey M. Toth, Edwin M. Nemoto, and A. Simon Turner. "Use of polylactide resorbable film as an adhesion barrier." Journal of Neurosurgery: Spine 97, no. 4 (November 2002): 413–22. http://dx.doi.org/10.3171/spi.2002.97.4.0413.

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Object. The present investigation evaluates two thicknesses of a resorbable polylactic acid (PLA) barrier film as an adhesion barrier to posterior spinal scar formation. Methods. A readily contourable, thin film was placed directly over the dura. The thick film was placed above the lamina defect to act as a physical barrier inhibiting the prolapse of soft tissue into the epidural space. Through a combination of gross dissection with and without scar scores, quantitative analysis of collagen adjacent to the scar site, and histological evaluation, the resorbable adhesion barrier membranes were found to be effective treatment for reduction of posterior adhesions. Conclusions. The gross dissection demonstrated that both thicknesses of resorbable PLA barrier films created a controlled dissection plane, facilitated access to the epidural space, and provided a reduction in the tissue adherent to the dura.

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Preul, Mark C., Patrick K. Campbell, David S. Garlick, and Robert F. Spetzler. "Application of a new hydrogel dural sealant that reduces epidural adhesion formation: evaluation in a large animal laminectomy model." Journal of Neurosurgery: Spine 12, no. 4 (April 2010): 381–90. http://dx.doi.org/10.3171/2009.10.spine09537.

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Object The aim of this study was to evaluate the application and effects of a novel, nonswelling, polyethylene glycol-based hydrogel adhesion barrier and sealant in a canine laminectomy model of CSF leakage and adhesion formation. Methods After full-width L-2 and L-5 laminectomies, 1-cm midline durotomies were created and sutured closed, except for the last 1–2 mm on the cranial end to create spontaneous CSF leakage. All 5 control animals received no further treatment. Experimental animals received hydrogel at both durotomy sites via either the Dual Liquid applicator (5 animals) or MicroMyst gas-assisted sprayer (5 animals). Sealing of the CSF leak was confirmed by Valsalva maneuver. At 2 months, 2 animals from each group were killed to evaluate dural healing and epidural adhesion formation. The remaining animals were similarly evaluated 4 months after surgery. One animal died at 66 days due to a cause unrelated to hydrogel treatment. Results In hydrogel-treated animals, all leaking durotomies were sealed intraoperatively. All animals recovered uneventfully. There were no treatment-related health effects. MicroMyst hydrogel application was more controlled, slower, and significantly less thick (p = 0.0094) than Dual Liquid application. All 5 control animals developed subcutaneous CSF accumulations under the incision within days of surgery, compared with only 1 of 10 hydrogel-treated animals (p = 0.002). At 2 and 4 months, control laminectomy sites showed extensive, dense epidural adhesions blending with neodura, compared with hydrogel-treated sites (p < 0.0001 and p = 0.0234, respectively). At 2 months in hydrogel-treated animals, gel filled the epidural space and no epidural adhesions were noted (p < 0.0001 relative to controls). At 4 months, the hydrogel was absorbed. The hydrogel space was filled with scant, loosely organized connective tissue. Conclusions Hydrogel prevented CSF leakage and mitigated epidural scarring without affecting healing of the dura or laminectomy site. The safety profile of the hydrogel appears favorable due to its synthetic composition, polyethylene glycol chemistry, minimal local tissue response, and lack of neurological deficits. Controlled application of such hydrogel materials may reduce the incidence of postoperative leaks, prevent adhesion formation and thus improve recovery from spinal surgery, and improve identification of tissue planes for reoperations.

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Birkenmaier, Christof. "A Biomechanical Evaluation of the Epidural Neurolysis Procedure." Pain Physician 1;15, no. 1;1 (January 14, 2012): E89—E97. http://dx.doi.org/10.36076/ppj.2012/15/e89.

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Background: The epidural lysis of adhesions (ELOA) procedure supposedly has a biomechanical component in addition to the targeted injection of medications into the epidural space. It is assumed that the catheters used for the ELOA procedure can release epidural scars and adhesions. Objectives: To evaluate the possible biomechanical effects of the typically used catheters and to put these effects into clinical perspective. Study Design: Experimental study. Setting: The biomechanical laboratory of an academic orthopedic surgery department. Methods: Experimental setups were devised that allow for the measurement of the 3 main forces that can be exerted by manipulating a catheter in the epidural space or by injecting fluids through such a catheter: axial forces, torsional forces, and hydraulic effects. Results: The maximum axial forces measured under extremely tight catheter guidance were 7 newton (N), whereas the maximum forces under conditions that more likely reflect a real treatment situation were between 1 and 2 N. The maximum torsional forces measured were 0.3 N under extremely tight catheter guidance and 0.01 N under more realistic conditions. The maximum flow that could be achieved through the typical catheter using normal saline and the maximum possible thumb pressure onto a 5 mL or a 10 mL Luer-Lock syringe was 0.48 mL/ s. Given these results and other data available to us, it appears impossible that the ELOA procedure with typically used catheters has any relevant mechanical effect. Limitations: Like with any experimental study, the realities of an in vivo situation can only be modeled to a limited degree. The main limitation of our study is that we cannot calculate, measure, or simulate neither the flow resistance between an epidural adhesion pocket and the open, local epidural space nor the flow resistance between the open, local epidural space and the larger epidural space as well as the retroperitoneal space. Conclusions: According to our findings and arguments, the ELOA procedure is predominantly a method for the highly targeted application of epidural medications and possibly also has a lavage effect. A mechanical lysis of scars or adhesions appears unlikely. Key words: epidural lysis of adhesions, epidural neurolysis, epidural neuroplasty, biomechanical, experimental, epidural, catheter, back pain, sciatica

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Liu, Song, Jean Pierre Boutrand, Jacques Bittoun, and Marc Tadie. "A collagen-based sealant to prevent in vivo reformation of epidural scar adhesions in an adult rat laminectomy model." Journal of Neurosurgery: Spine 97, no. 1 (July 2002): 69–74. http://dx.doi.org/10.3171/spi.2002.97.1.0069.

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Object. The authors investigated the effect of a collagen-based sealant, Gel Amidon Oxydé (GAO), in preventing the reformation of epidural scar adhesions in an adult rat model of laminectomy. Methods. Thirty-two adult Sprague—Dawley rats underwent a complete L5–6 laminectomy, after which the dura mater was exposed and the left adjacent L-4 and L-5 nerve roots were exposed. The surgical wound was then closed; 1 month later it was reopened. The epidural scar adhesions that developed were observed and carefully removed, leaving clean dura and nerve roots reexposed. In 16 experimental rats, GAO was placed onto the reexposed dura and around the nerve roots before it polymerized. No treatment was performed in 16 control rats. Postoperatively, all rats were healthy and without neurological deficit. The incisions healed within 1 week regardless of the treatment with the GAO. Three months after reoperation, magnetic resonance imaging revealed that important epidural adhesions were present in the control rats but not in the experimental rats. These findings were then confirmed by gross anatomical examination in which a white tissue layer was found over the dura without adhesions in the experimental animals, whereas significant epidural scar adhesions were demonstrated in the controls. Histological evaluation of the laminectomy site also showed that the peridural space in the experimental rats was larger than that in the controls. Conclusions. The authors found that GAO may be a safe and effective antiscarring adhesion biomaterial in vivo. When placed into the laminectomy site, GAO may prove beneficial in preventing the formation and reformation of epidural scar adhesions in humans.

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Liu, Song, Jean Pierre Boutrand, and Marc Tadie. "Use of a collagen-based sealant to prevent in vivo epidural adhesions in an adult rat laminectomy model." Journal of Neurosurgery: Spine 94, no. 1 (January 2001): 61–67. http://dx.doi.org/10.3171/spi.2001.94.1.0061.

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Object. The authors investigated the effect of a collagen-based sealant, Gel Amidon Oxydé (GAO), in the prevention of epidural scar adhesions in an adult rat model of laminectomy. Methods. Seventy-two adult Sprague—Dawley rats underwent an L5–6 laminectomy, after which the dura mater and the left L-4 and L-5 nerve roots were exposed. In the 36 animals that received GAO, the sealant was applied over the dura and around the nerve roots, and it was used to fill the laminectomy cavity before it polymerized. In 36 control animals, the same surgical treatment was performed, but the rats did not receive GAO. During the early postoperative period, a significant decrease in the occurrence of epidural hematoma was found in the GAO-treated rats. In contrast to findings in control rats, a thin white connective tissue layer was found between the dura and surrounding muscles after GAO had degraded and been absorbed. One month posttreatment, no epidural scar adhesion was found between the tissue layer and the dura in the GAO-treated animals. Three months postoperatively, both gross inspection and histological examination further confirmed that formation of epidural adhesions was significantly inhibited in the rats treated with GAO. No special inflammatory reaction was observed, and the healing of skin and muscle lesions was not affected by either treatment. Conclusions. The data obtained in this study suggest that the GAO collagen—based sealant may be an effective biomaterial to prevent epidural adhesions in vivo after laminectomy.

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Fishchenko, Ya, D. Zavodovskyi, T. Matvienko, D. Nozdrenko, and O. Motuzyuk. "Structural changes of spinal cord fibrosis due to epidural application of mixture of longidaza and diprospa." Bulletin of Taras Shevchenko National University of Kyiv. Series: Problems of Physiological Functions Regulation 20, no. 1 (2016): 49–53. http://dx.doi.org/10.17721/2616_6410.2016.20.49-53.

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Changes in structure of fibrosis of rat spinal cord induced using intervertebral disc rupture fibers method due to application longidaza and diprospan mixture. Simultanious epidural application of hyaluronidase and betamethasone in preparation of diprospan and longidasa had high synergistic effect and antifibrosis activity. Through anti-inflammatory effect and ability to reduce epidural scars adhesion this complex, to our opinion, has perspective in therapy of epidural spinal cord fibrosis.

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Lee, Jin-Yul, Werner Stenzel, Heinrich Ebel, Christoph Wedekind, Ralf-Ingo Ernestus, and Norfrid Klug. "Mitomycin C in preventing spinal epidural fibrosis in a laminectomy model in rats." Journal of Neurosurgery: Spine 100, no. 1 (January 2004): 52–55. http://dx.doi.org/10.3171/spi.2004.100.1.0052.

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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.

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Erdyneev, K. Ts, V. A. Sorokovikov, D. N. Sambuev, V. P. Saganov, and P. M. Zherbakhanov. "The use of various materials and drugs for the prevention of the development of postoperative lumbar epidural fibrosis: literature review." Hirurgiâ pozvonočnika (Spine Surgery) 18, no. 2 (June 8, 2021): 83–92. http://dx.doi.org/10.14531/ss2021.2.83-92.

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The paper is a review of the current literature data on the use of various materials and drugs for the prevention of the development of postoperative lumbar epidural fibrosis. Literature searches were performed in the Pubmed, Medline, EMBASE, Cochrane Library and eLibrary databases. The formation and growth of fibrous tissue in the epidural space, followed by tissue adhesion to the dura mater, is the leading cause of pain afferentation in the lumbar spine and/or lower extremities. Several molecular and cellular mechanisms play an important role in the pathophysiology of connective tissue formation in the epidural space. An analysis of experimental and clinical studies examining the effectiveness of various materials and drugs is presented. The authors present the current data on new therapeutic approaches to the prevention of postoperative epidural fibrosis. Topical, unresolved issues which necessitate further research on the pathophysiology of epidural fibrosis are indicated.

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Richards, Peter J., A. Simon Turner, Serge M. Gisler, Susan Kraft, Katja Nuss, Silke Mark, Howard B. Seim, and Jason Schense. "Reduction in postlaminectomy epidural adhesions in sheep using a fibrin sealant-based medicated adhesion barrier." Journal of Biomedical Materials Research Part B: Applied Biomaterials 9999B (2009): NA. http://dx.doi.org/10.1002/jbm.b.31533.

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Jiao, Genlong, Zhizhong Li, Pan Zhou, Jinpei Yang, and Xueshi Li. "Clinical outcomes of epidural and intradural decompression for treatment of degenerative cervical myelopathy." Journal of International Medical Research 48, no. 6 (June 2020): 030006052092958. http://dx.doi.org/10.1177/0300060520929585.

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Objective This study was performed to examine the clinical outcomes of epidural and intradural decompression for degenerative cervical myelopathy. Methods The data for 13 patients who underwent epidural and intradural decompression for treatment of degenerative cervical myelopathy (study group) and 20 patients who underwent only cervical laminoplasty, fusion, and epidural decompression (historical control group) were retrospectively reviewed. The preoperative and postoperative neurological status was evaluated using the Japanese Orthopaedic Association (JOA) score. Results All patients’ neurological symptoms were significantly improved at the final follow-up. In the study group, the patients’ mean preoperative JOA score was 8.07 ± 1.80, and the final score improved by 70.88% ± 21.18%. The blood loss and operation time were significantly greater in the study group than control group. The recovery time was shorter in the study group than control group. The improvement rate was not significantly different between the two groups. Conclusions A pia mater incision with separation of the arachnoid adhesion can significantly improve the cerebrospinal fluid flow and spinal blood flow in degenerative cervical myelopathy. Arachnoid adhesion can lead to intradural spinal scar compression. The surgical intervention described herein can achieve satisfactory neurological outcomes and shorten the recovery time.

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Wang, Yan, Lanlan Li, Yongchang Ma, Yong Tang, Yang Zhao, Zimeng Li, Wendan Pu, et al. "Multifunctional Supramolecular Hydrogel for Prevention of Epidural Adhesion after Laminectomy." ACS Nano 14, no. 7 (June 10, 2020): 8202–19. http://dx.doi.org/10.1021/acsnano.0c01658.

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Shin, Jin Woo. "Is Epidurogram a Reliable Tool for the Diagnosis of Epidural Adhesion?" Korean Journal of Pain 25, no. 2 (2012): 133. http://dx.doi.org/10.3344/kjp.2012.25.2.133.

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Wang, Huailan, Wenjia Sun, Dongliang Fu, Yueliang Shen, Ying-ying Chen, and Lin-lin Wang. "Update on biomaterials for prevention of epidural adhesion after lumbar laminectomy." Journal of Orthopaedic Translation 13 (April 2018): 41–49. http://dx.doi.org/10.1016/j.jot.2018.02.001.

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Freise, Hendrik, Stefan Lauer, Eva Konietzny, Juergen Hinkelmann, Evgeni Minin, Hugo K. Van Aken, Markus M. Lerch, Andreas W. Sielenkaemper, and Lars G. Fischer. "Hepatic Effects of Thoracic Epidural Analgesia in Experimental Severe Acute Pancreatitis." Anesthesiology 111, no. 6 (December 1, 2009): 1249–56. http://dx.doi.org/10.1097/aln.0b013e3181c1494e.

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Background Thoracic epidural anesthesia (TEA) protects the intestinal microcirculation and improves perioperative outcomes. TEA also reduces mortality in acute experimental pancreatitis. Its impact on hepatic microcirculation, however, in health and critical illness is unknown. Therefore, the authors studied the effect of TEA on the liver in healthy rats and in experimental severe acute pancreatitis. Methods TEA was induced by 15 microl/h bupivacaine, 0.5%. Necrotizing pancreatitis was induced by intraductal infusion of 2 ml/kg taurocholic acid, 5%. Twenty-eight rats were assigned to either Sham operation, Sham + TEA, Pancreatitis, or Pancreatitis + TEA. After 15 h, mean arterial pressure, heart rate, and respiratory function were recorded. Sinusoidal width and perfusion rate and the intrahepatic leukocyte adhesion were assessed by intravital microscopy. In an additional 22 rats randomly assigned to Sham, Pancreatitis, and Pancreatitis + TEA, hepatic apoptosis was evaluated by staining for single-stranded DNA and Fas ligand-positive cells. Results TEA did not affect hepatic microcirculation and leukocyte adhesion in healthy rats. Blood pressure remained unchanged in the Sham + TEA group. In Pancreatitis, mean arterial pressure decreased from 141 + or - 6 mmHg to 127 + or - 13 mmHg but remained stable in Pancreatitis + TEA. The sinusoidal diameter decreased from 5.4 + or - 0.1 microm to 5.0 + or - 0.2 microm in Pancreatitis. This was restored in Pancreatitis + TEA. Intrahepatic leukocyte adhesion was not affected by TEA. The increased hepatocyte apoptosis in Pancreatitis was abolished in Pancreatitis + TEA. This might be mediated by inhibition of the Fas ligand pathway. Conclusion TEA reduces liver injury in necrotizing acute pancreatitis. This could be related to a regional sympathetic block. TEA could thus preserve liver function in systemic inflammatory disorders such as acute pancreatitis.

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Han, In-Ho, Keun-Su Kim, and Byung-Ho Jin. "Intradural Lumbar Disc Herniations Associated with Epidural Adhesion : Report of Two Cases." Journal of Korean Neurosurgical Society 46, no. 2 (2009): 168. http://dx.doi.org/10.3340/jkns.2009.46.2.168.

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Freise, H., S. Lauer, M. Fobker, H. Van Aken, A. Sielenkaemper, and L. Fischer. "Thoracic epidural anesthesia modifies hepatic perfusion and leukocyte adhesion in septic rats." European Journal of Anaesthesiology 23, Supplement 37 (June 2006): 131. http://dx.doi.org/10.1097/00003643-200606001-00469.

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Brkljaca Bottegaro, N., J. Kos, B. Pirkic, O. Smolec, Z. Grabarevic, M. Hohsteter, J. Selanec, and Z. Vrbanac. "Reduction of epidural fibrosis after laminectomy in rabbits by omental free graft." Veterinární Medicína 58, No. 1 (February 22, 2013): 25–31. http://dx.doi.org/10.17221/6653-vetmed.

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Epidural fibrosis is an extradural scar tissue formed after a laminectomy procedure. It is associated with persistent pain after spinal surgery and an increased risk of complications during revision surgery. The aim of this study was to determine the preventive effects of local application of an omental free graft in minimising spinal epidural fibrosis in a rabbit laminectomy model. Twenty two rabbits were randomly divided in two groups, a control group of seven and an experimental group of 15 animals. A dorsal laminectomy at levels L1 to L3 was performed on each rabbit of both groups. Prior to the laminectomy procedure, the animals from the experimental group were submitted to a laparotomy in order to obtain the free omental graft. The graft was then applied to the same animal at the dural deffect. All rabbits were euthanised six weeks after surgery and spine segments L1 to L3 were removed. Histological sections were evaluated for fibrosis intensity at the laminectomy level, the adhesion degree between dura mater and fibrous tissue and the presence of the foreign body reaction. A statistically significant correlation was established for the foreign body reaction presence and belonging to the group, which can be explained by the omental effects on inflammation reduction and healing promotion. The degree of adhesion between the dura mater and fibrous tissue and the intensity of the fibrous tissue at the laminectomy level were lower in the experimental group although the differences were not statistically significant. The use of free omental grafts is thus a promising technique in epidural fibrosis prevention.

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Kim, Young Ha, Chi Hyung Lee, Chang Hyeun Kim, Dong Wuk Son, Sang Weon Lee, Geun Sung Song, and Soon Ki Sung. "Clinical Efficacy and Safety of Silicone Elastomer Sheet during Decompressive Craniectomy: Anti-Adhesive Role in Cranioplasty." Brain Sciences 11, no. 1 (January 18, 2021): 124. http://dx.doi.org/10.3390/brainsci11010124.

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(1) Background: Cranioplasty is a surgery to repair a skull bone defect after decompressive craniectomy (DC). If the process of dissection of the epidural adhesion tissue is not performed properly, it can cause many complications. We reviewed the effect of a silicone elastomer sheet designed to prevent adhesion. (2) Methods: We retrospectively reviewed 81 consecutive patients who underwent DC and subsequent cranioplasty at our institution between January 2015 and December 2019. We then divided the patients into two groups, one not using the silicone elastomer sheet (n = 50) and the other using the silicone elastomer sheet (n = 31), and compared the surgical outcomes. (3) Results: We found that the use of the sheet shortened the operation time by 24% and reduced the estimated blood loss (EBL) by 43% compared to the control group. Moreover, the complication rate of epidural fluid collection (EFC) in the group using the sheet was 16.7%, which was lower than that in the control group (41.7%, p < 0.023). Multivariate logistic regression analysis showed the sheet (OR 0.294, 95% CI 0.093–0.934, p = 0.039) to be significantly related to EFC. (4) Conclusions: The technique using the silicone elastomer sheet allows surgeons to easily dissect the surgical plane during cranioplasty, which shortens the operation time, reduces EBL, and minimizes complications of EFC.

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Chen, Hsuan-Yu, Tzu-Chieh Lin, Chih-Yung Chiang, Shiuan-Li Wey, Feng-Huei Lin, Kai-Chiang Yang, Chih-Hao Chang, and Ming-Hsiao Hu. "Antifibrotic Effect of Bletilla striata Polysaccharide-Resveratrol-Impregnated Dual-Layer Carboxymethyl Cellulose-Based Sponge for The Prevention of Epidural Fibrosis after Laminectomy." Polymers 13, no. 13 (June 29, 2021): 2129. http://dx.doi.org/10.3390/polym13132129.

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The application of antifibrotic materials can alleviate epidural fibrosis by restricting excessive fibroblast proliferation and mitigating scar tissue formation. Here, a biodegradable carboxymethyl cellulose (CMC)-Bletilla striata polysaccharide (BSP)-resveratrol (RES) sponge was fabricated to inhibit scar tissue formation post laminectomy surgery. Fibroblasts NIH/3T3, myoblasts C2C12, neural cells PC-12, and Schwann cells RSC96 were used to evaluate the in vitro cytocompatibility. Laminectomies on 10 Sprague–Dawley rats with/without the application of the CMC-BSP-RES sponge were performed. The severity of adhesion between the dura mater and formed scar tissue was qualitatively scored. All cell lines exhibited good viability with no significant difference in cytotoxicity when cultured with variable extractions of the CMC-BSP-RES sponge. S100a4 and P4hb expressions were downregulated in NIH/3T3 cultured in the CMC-BSP-RES sponge, implying that this sponge potentially inhibits fibroblast activity. No post-operative shrinkage or dura mater expansion along the surgical site was detected. The peel-off tests revealed that the tenacity of adhesion de-creased. Histopathological examinations verified that the average number of fibroblasts in the CMC-BSP-RES group considerably decreased. The CMC-BSP-RES sponge is a biocompatible and effective material for alleviating post-operative epidural fibrosis and mitigating fibroblast expression following laminectomy.

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Erdyneev, K. Ts, V. A. Sorokovikov, D. N. Sambuev, V. P. Saganov, B. B. Dambaev, S. N. Larionov, O. A. Goldberg, S. A. Lepekhova, and I. A. Stepanov. "The effectiveness of spatially cross-linked polymer in the postoperative epidural fibrosis prevention: an experimental study." Acta Biomedica Scientifica 6, no. 3 (August 17, 2021): 174–84. http://dx.doi.org/10.29413/abs.2021-6.3.18.

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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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Choi, Hyu Jin, Kyoung Beom Kim, and Young-Min Kwon. "Effect of Amniotic Membrane to Reduce Postlaminectomy Epidural Adhesion on a Rat Model." Journal of Korean Neurosurgical Society 49, no. 6 (2011): 323. http://dx.doi.org/10.3340/jkns.2011.49.6.323.

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Fan, Qingxin, Hao Wu, and Qingquan Kong. "Superhydrophilic PLGA-Graft-PVP/PC Nanofiber Membranes for the Prevention of Epidural Adhesion." International Journal of Nanomedicine Volume 17 (March 2022): 1423–35. http://dx.doi.org/10.2147/ijn.s356250.

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Li, Jianwen, Zhongjia He, Xianyin Liu, Songbo Li, Yuchao Yin, Guanjun Fang, Yaoxin Chen, et al. "3D-Printed Bionic Titanium Alloy Artificial Lamina Prevents Epidural Adhesion and Restores the Stability After Laminectomy in Pigs." Journal of Biomedical Nanotechnology 18, no. 3 (March 1, 2022): 875–83. http://dx.doi.org/10.1166/jbn.2022.3290.

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Laminectomy can cause the dura mater to adhere to the surrounding scar tissue, leading to soft spinal stenosis after surgery. Although artificial laminae are considered ideal substitutes, they present challenges such as insecure fixation and insufficient bionics. In this study, we fabricated a bionic titanium alloy artificial lamina using three-dimensional (3D)-printing technology and evaluated its adhesion prevention and stability after laminectomy in pigs. An in vitro biomechanical pull-out resistance test indicated that the pull-out strength of the artificial lamina was close to that of a single pedicle screw and was significantly higher than that of a cortical screw. In vivo animal implantation results indicated precise laminectomy and artificial lamina implantation, as well as a safe operation process with the assistance of guide plates. X-ray and computed tomography results indicated the well fixation of bionic titanium alloy artificial lamina and screws 10 weeks after laminectomy. The artificial lamina was not loosened after being removed from pigs (postoperative week 12), exhibiting good stability. Additionally, no adhesion was observed in the artificial lamina group, whereas a large amount of scar tissue in the spinal canal covered the dural surface in the control group. Thus, 3D-printed bionic titanium alloy artificial lamina can prevent epidural adhesion after laminectomy, while restoring the structural stability of the posterior complex, suggesting the potential of lamina substitutes for adhesion prevention after laminectomy.

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Mulyawan, Wawan, Yudi Yuwono Wiwoho, and Syaiful Ichwan. "PERCUTANEOUS EPIDURAL NEUROPLASTY (PEN) USING COMBINATION OF HYALURONIDASE AND HYPERTONIC SALINE (NaCl 3%) IN TREATING FAILED BACK SURGERY SYNDROME." Neurologico Spinale Medico Chirurgico 1, no. 1 (June 18, 2018): 1. http://dx.doi.org/10.15562/nsmc.v1i1.1.

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Background: Following surgical treatments for low back pain, lower extremity pain or neurologic symptoms would last or recur, this is defined as failed sack surgery syndrome (FBSS). FBSS usually occurs in 5-40% of these surgical patients. The most common cause is an epidural scar adhesion. Percutaneous epidural neuroplasty is the non-mechanical treatment for this condition. Previously, the use of hyaluronidase and hypertonic saline separately is commonly used for epidurolysis but the combination of hyaluronidase and hypertonic saline 3% has not been explored.Objective: To investigate the two-year outcomes of percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% in patients with FBSS.Methods: Twelve patients who experience low back pain, with or without radiculopathy, who have underwent lumbar spine surgery previously were assigned to the study. Parameters, such as the visual analogue scale scores for the back (VAS-B) and legs (VAS-L), and the Oswestry disability index (ODI), were recorded and compared between pretreatment, 1 week, 1 month, 3 months, 1 year and 2 years follow-up.Results: For all 12 patients, the postoperative VAS-B, VAS-L, and ODI were significantly different from the preoperative values in all follow-up periods: 1 month, 3 months, 1 year, and 2 years.Conclusion: Based off this study group, percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% has a favourable outcome in the 2 years follow-up

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Su, Changhui, Changjiang Yao, Shenghua Lu, Ailiang Zhang, Xiaojian Cao, Gaojun Teng, and Fengchao Zang. "Study on the optimal concentration of topical mitomycin-C in preventing postlaminectomy epidural adhesion." European Journal of Pharmacology 640, no. 1-3 (August 2010): 63–67. http://dx.doi.org/10.1016/j.ejphar.2010.04.039.

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Yan, Lianqi, Xiaolei Li, Jingcheng Wang, Yu Sun, Daxing Wang, Jiaxiang Gu, Jinshan He, et al. "Immunomodulatory effectiveness of tacrolimus in preventing epidural scar adhesion after laminectomy in rat model." European Journal of Pharmacology 699, no. 1-3 (January 2013): 194–99. http://dx.doi.org/10.1016/j.ejphar.2012.11.037.

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Lima, Rodrigo. "Clinical and Histological Effects of the Intrathecal Administration of Methylprednisolone in Dogs." Pain Physician 5;13, no. 5;9 (September 14, 2010): 493–501. http://dx.doi.org/10.36076/ppj.2010/13/493.

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Background: Methylprednisolone is one of the most commonly used steroids for management of chronic back pain via epidural injection. Its inadvertent injection into the intrathecal space is associated with complications such as adhesive arachnoiditis. Objective: The present study aimed to assess the clinical and histological changes associated with the injection of methylprednisolone into the intrathecal space of dogs. Study Design: A randomized, double blind, controlled animal trial. Methods: After approval by the animal research ethics committee, 14 dogs were studied in a randomized double blind controlled trial. They were assigned to one of 2 groups: Group I received 1 mL of 0.9% normal saline; Group II received 1 mL (1.15mg/kg) of methylprednisolone into the intrathecal space. Animals were clinically evaluated for 21 days, and then sacrificed. The lumbar and sacral portions of their spinal cords were removed for histological examination. Results: In Group I, there were no clinical or histological changes. All animals in Group II showed no clinical changes but all exhibited histological changes in the spinal cord. The main histological changes consisted of meningeal thickening and lymphocytic infiltrates in the blood vessels. In 3 animals, adhesion of pia, arachnoid, and dura matter was noted and the nerve roots were surrounded by fibrosis. In one animal, necrosis of the spinal cord was evident. Limitations: The limitations of the present study include: small sample of animals (n=14), relative short clinical follow-up (21 days), and use of a commercially available drug solution, which is not preservative free. Conclusion: The present study demonstrated that the intrathecal administration of commercially available methylprednisolone was responsible for causing histological changes in the spinal cord and meninges of the animals studied. Key words: Methylprednisolone; intrathecal injection; steroids; adhesive arachnoiditis; low back pain; epidural injection; spinal cord.

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Freise, Hendrik, Fritz Daudel, Christina Grosserichter, Stefan Lauer, Juergen Hinkelmann, Hugo K. Van Aken, Andreas W. Sielenkaemper, Martin Westphal, and Lars G. Fischer. "Thoracic epidural anesthesia reverses sepsis-induced hepatic hyperperfusion and reduces leukocyte adhesion in septic rats." Critical Care 13, no. 4 (2009): R116. http://dx.doi.org/10.1186/cc7965.

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Liu, Hua, Hai-Feng Li, and Jian-Yuan Wang. "Prevention effect of medical self-crosslinking sodium hyaluronate gel on epidural scar adhesion after laminectomy." Asian Pacific Journal of Tropical Medicine 7, no. 6 (June 2014): 501–4. http://dx.doi.org/10.1016/s1995-7645(14)60083-3.

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Lee, Juan Hwan. "Clinical Effectiveness of Percutaneous Adhesiolysis Using Navicath for the Management of Chronic Pain Due to Lumbosacral Disc Herniation." Pain Physician 3;15, no. 3;5 (May 14, 2012): 213–23. http://dx.doi.org/10.36076/ppj.2012/15/213.

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Background: Epidural steroid injection has been frequently performed to treat chronic pain due to lumbosacral disc herniation (L-HIVD). However, a considerable number of patients do not achieve pain relief using this method because perineural or epidural adhesions prevent the spread of injectate into the epidural space. Percutaneous adhesiolysis (PA) is thought to be a useful method because it can eliminate the deleterious effects of adhesion. Objectives: This study aimed to evaluate the effectiveness of PA in managing chronic pain due to L-HIVD and the clinical and radiological predictive factors for the effectiveness of PA using NaviCath®. Study design: Retrospective study Setting: Spine hospital Methods: From a group of patients diagnosed with L-HIVD, we selected the 86 patients who underwent PA with NaviCath who had experienced chronic lower back or leg pain for at least 3 months and had failed to respond to anti-inflammatory medications or physical therapy of at least 1 month’s duration and fluoroscopy guided transforaminal epidural injection. We recorded the Numeric Rating Scale for back pain (NRS back) and leg pain (NRS leg) and the Oswestry Disability Index (ODI) at pretreatment, 2 weeks, and 3 months after treatment. Clinical data and magnetic resonance imaging (MRI) findings were obtained to assess the possible predictive factors for PA efficacy. Limitations: Retrospective chart review without a control group. Results: At 2 weeks after PA, significant improvement was observed in NRS back, NRS leg, and ODI compared with pretreatment. This improvement was maintained until 3 months after treatment. Among 86 patients, 61 (70.9%), 53 (61.6%) and 61 patients (70.9%) showed successful outcomes in NRS back, NRS leg, and ODI at 2 weeks, respectively. Among 74 patients who were followed up at 3 months, 47 (63.5%), 44 patients (59.5%), and 50 patients (67.6%) showed successful results in NRS back, NRS leg, and ODI at 3 months, respectively. A significantly higher proportion of patients with a history of previous lumbar surgery showed unsuccessful results on NRS back, NRS leg, and ODI scores at 2 weeks and 3 months. Co-existence of spinal stenosis was associated with a significantly higher proportion of unsuccessful results in NRS back and ODI at 2 weeks and 3 months, as well as NRS leg at 3 months. Patients with spondylolisthesis also showed a significantly higher proportion of unsuccessful results in NRS and ODI at 2 weeks. Conclusion: PA with NaviCath showed clinical effectiveness in the treatment of chronic pain due to L-HIVD that was not responsive to transforaminal epidural injection. Previous surgery and the presence of spinal stenosis or spondylolisthesis were poor prognostic predictors. This procedure may enable the physician to place the catheter tip and deliver medicine more precisely. Key words: Percutaneous adhesiolysis, lumbosacral disc herniation, Numeric Rating Scale, Oswetry Disability Index

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Zhang, Chao, Xiaohong Kong, Hengxing Zhou, Chang Liu, Xuechao Zhao, Xianhu Zhou, Yanhua Su, Hari S. Sharma, and Shiqing Feng. "An Experimental Novel Study:Angelica sinensisPrevents Epidural Fibrosis in Laminectomy Rats via Downregulation of Hydroxyproline, IL-6, and TGF-β1." Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/291814.

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With laminectomy being widely accepted as the treatment for lumbar disorders, epidural fibrosis (EF) is a common complication for both the patients and the surgeons alike. Currently, EF is thought to cause recurrent postoperative pain after laminectomy or after discectomy.Angelica sinensisis a traditional Chinese medicine which has shown anti-inflammatory, antifibrotic, and antiproliferative properties. The object of this study was to investigate the effects ofAngelica sinensison the prevention of post-laminectomy EF formation in a rat model. A controlled double-blinded study was conducted in sixty healthy adult Wistar rats that underwent laminectomy at the L1-L2 levels. They were divided randomly into 3 groups according to the treatment method, with 20 in each group: (1)Angelica sinensistreatment group, (2) saline treatment group, and (3) sham group (laminectomy without treatment). All rats were euthanized humanely 4 weeks after laminectomy. The hydroxyproline content, Rydell score, vimentin cells density, fibroblasts density, inflammatory cells density, and inflammatory factors expressions all suggested better results inAngelica sinensisgroup than the other two groups. Topical application ofAngelica sinensiscould inhibit fibroblasts proliferation and TGF-β1 and IL-6 expressions and prevent epidural scar adhesion in postlaminectomy rat model.

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Sabuncuoğlu, Hakan, Murad Bavbek, Bizden Sabuncuoğlu, Eberval Gadelha, Kenan Köse, and Mark Preul. "Attenuation of postlaminectomy epidural fibrosis with monoclonal antibodies against intercellular adhesion molecule-1 and CD-18." Spine Journal 7, no. 4 (July 2007): 459–65. http://dx.doi.org/10.1016/j.spinee.2006.06.398.

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Rodgers, Kathleen E., James T. Robertson, Theresa Espinoza, Wilham Oppelt, Stephanie Cortese, Gere S. diZerega, and Richard A. Berg. "Reduction of epidural fibrosis in lumbar surgery with Oxiplex adhesion barriers of carboxymethylcellulose and polyethylene oxide." Spine Journal 3, no. 4 (July 2003): 277–83. http://dx.doi.org/10.1016/s1529-9430(03)00035-4.

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Smith, Gabriel A., Arshneel S. Kochar, Sunil Manjila, Kaine Onwuzulike, Robert T. Geertman, James S. Anderson, and Michael P. Steinmetz. "Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques." Neurosurgical Focus 37, no. 2 (August 2014): E11. http://dx.doi.org/10.3171/2014.5.focus14136.

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Despite the increasing prevalence of spinal infections, the subcategory of holospinal epidural abscesses (HEAs) is extremely infrequent and requires unique management. Panspinal imaging (preferably MRI), modern aggressive antibiotic therapy, and prompt surgical intervention remain the standard of care for all spinal axis infections including HEAs; however, the surgical decision making on timing and extent of the procedure still remain ill defined for HEAs. Decompression including skip laminectomies or laminoplasties is described, with varied clinical outcomes. In this review the authors present the illustrative cases of 2 patients with HEAs who were treated using skip laminectomies and epidural catheter irrigation techniques. The discussion highlights different management strategies including the role of conservative (nonsurgical) management in these lesions, especially with an already identified pathogen and the absence of mass effect on MRI or significant neurological defects. Among fewer than 25 case reports of HEA published in the past 25 years, the most important aspect in deciding a role for surgery is the neurological examination. Nearly 20% were treated successfully with medical therapy alone if neurologically intact. None of the reported cases had an associated cranial infection with HEA, because the dural adhesion around the foramen magnum prevented rostral spread of infection. Traditionally a posterior approach to the epidural space with irrigation is performed, unless an extensive focal ventral collection is causing cord compression. Surgical intervention for HEA should be an adjuvant treatment strategy for all acutely deteriorating patients, whereas aspiration of other infected sites like a psoas abscess can determine an infective pathogen, and appropriate antibiotic treatment may avoid surgical intervention in the neurologically intact patient.

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Islamov, Rustem, Farid Bashirov, Filip Fadeev, Roman Shevchenko, Andrei Izmailov, Vage Markosyan, Mikhail Sokolov, et al. "Epidural Stimulation Combined with Triple Gene Therapy for Spinal Cord Injury Treatment." International Journal of Molecular Sciences 21, no. 23 (November 24, 2020): 8896. http://dx.doi.org/10.3390/ijms21238896.

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The translation of new therapies for spinal cord injury to clinical trials can be facilitated with large animal models close in morpho-physiological scale to humans. Here, we report functional restoration and morphological reorganization after spinal contusion in pigs, following a combined treatment of locomotor training facilitated with epidural electrical stimulation (EES) and cell-mediated triple gene therapy with umbilical cord blood mononuclear cells overexpressing recombinant vascular endothelial growth factor, glial-derived neurotrophic factor, and neural cell adhesion molecule. Preliminary results obtained on a small sample of pigs 2 months after spinal contusion revealed the difference in post-traumatic spinal cord outcomes in control and treated animals. In treated pigs, motor performance was enabled by EES and the corresponding morpho-functional changes in hind limb skeletal muscles were accompanied by the reorganization of the glial cell, the reaction of stress cell, and synaptic proteins. Our data demonstrate effects of combined EES-facilitated motor training and cell-mediated triple gene therapy after spinal contusion in large animals, informing a background for further animal studies and clinical translation.

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Alahi, Md Eshrat E., Yonghong Liu, Sara Khademi, Anindya Nag, Hao Wang, Tianzhun Wu, and Subhas Chandra Mukhopadhyay. "Slippery Epidural ECoG Electrode for High-Performance Neural Recording and Interface." Biosensors 12, no. 11 (November 18, 2022): 1044. http://dx.doi.org/10.3390/bios12111044.

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Chronic implantation of an epidural Electrocorticography (ECoG) electrode produces thickening of the dura mater and proliferation of the fibrosis around the interface sites, which is a significant concern for chronic neural ECoG recording applications used to monitor various neurodegenerative diseases. This study describes a new approach to developing a slippery liquid-infused porous surface (SLIPS) on the flexible ECoG electrode for a chronic neural interface with the advantage of increased cell adhesion. In the demonstration, the electrode was fabricated on the polyimide (PI) substrate, and platinum (Pt)-gray was used for creating the porous nanocone structure for infusing the silicone oil. The combination of nanocone and the infused slippery oil layer created the SLIPS coating, which has a low impedance (4.68 kΩ) level favourable for neural recording applications. The electrochemical impedance spectroscopy and equivalent circuit modelling also showed the effect of the coating on the recording site. The cytotoxicity study demonstrated that the coating does not have any cytotoxic potentiality; hence, it is biocompatible for human implantation. The in vivo (acute recording) neural recording on the rat model also confirmed that the noise level could be reduced significantly (nearly 50%) and is helpful for chronic ECoG recording for more extended neural signal recording applications.

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Sun, Yu, Lei Wang, Sixin Sun, Bo Liu, Naiqing Wu, and Xiaojian Cao. "The effect of 10-hydroxycamptothecine in preventing fibroblast proliferation and epidural scar adhesion after laminectomy in rats." European Journal of Pharmacology 593, no. 1-3 (September 2008): 44–48. http://dx.doi.org/10.1016/j.ejphar.2008.07.028.

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Chen, Lin, Xiang-qian Li, Lu-ping Cao, Xi-lei Li, Jun-rong Meng, Jian Dong, Lin Yu, and Jian-dong Ding. "An injectable hydrogel with or without drugs for prevention of epidural scar adhesion after laminectomy in rats." Chinese Journal of Polymer Science 34, no. 2 (December 12, 2015): 147–63. http://dx.doi.org/10.1007/s10118-016-1740-5.

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Isık, Semra, M. Özgür Taşkapılıoğlu, Fatma Oz Atalay, and Seref Dogan. "Effects of cross-linked high-molecular-weight hyaluronic acid on epidural fibrosis: experimental study." Journal of Neurosurgery: Spine 22, no. 1 (January 2015): 94–100. http://dx.doi.org/10.3171/2014.10.spine131147.

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OBJECT Epidural fibrosis is nonphysiological scar formation, usually at the site of neurosurgical access into the spinal canal, in the intimate vicinity of and around the origin of the radicular sheath. The formation of dense fibrous tissue causes lumbar and radicular pain. In addition to radicular symptoms, the formation of scar tissue may cause problems during reoperation. The authors aimed to investigate the effects of cross-linked high-molecular-weight hyaluronic acid (HA), an HA derivative known as HA gel, on the prevention of epidural fibrosis by using histopathological and biochemical parameters. METHODS Fifty-six adult female Sprague-Dawley rats were evaluated. The rats were divided into 4 groups. Rats in the sham group (n = 14) underwent laminectomy and discectomy and received no treatment; rats in the control group (n = 14) underwent laminectomy and discectomy and received 0.9% NaCl treatment in the surgical area; rats in the HA group (n = 14) received HA treatment at the surgical area after laminectomy and discectomy; and rats in the HA gel group (n = 14) underwent laminectomy and discectomy in addition to receiving treatment with cross-linked high-molecular-weight HA in the surgical area. All rats were decapitated after 4 weeks, and the specimens were evaluated histopathologically and biochemically. The results were statistically compared using the Mann-Whitney U-test. RESULTS Compared with the sham and control groups, the HA and HA gel groups showed significantly lower fibroblast cell density and tissue hydroxyproline concentrations (p < 0.05). There was statistically significant lower dural adhesion and foreign-body reaction between the control and HA gel groups (p < 0.05). Granulation tissue and epidural fibrosis were significantly lower in the HA and HA gel groups compared with the sham group (p < 0.05). There were no significant differences in any histopathological parameters or biochemical values between Groups 3 and 4 (p > 0.05). CONCLUSIONS Cross-linked high-molecular-weight HA had positive effects on the prevention of epidural fibrosis and the reduction of fibrotic tissue density. The efficacy of this agent should also be verified in further experimental and clinical studies.

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Mastronardi, Luciano, Marco Pappagallo, Fabrizio Puzzilli, and Carlo Tatta. "Efficacy of the Morphine-Adcon-L Compound in the Management of Postoperative Pain after Lumbar Microdiscectomy." Neurosurgery 50, no. 3 (March 1, 2002): 518–25. http://dx.doi.org/10.1097/00006123-200203000-00017.

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Abstract OBJECTIVE: Epidural analgesia is a pharmacological technique for operative and postoperative pain control. It has been used with lumbar microdiscectomy to facilitate management of surgical pain, shorten patient recovery time, and increase patient satisfaction with the procedure and the hospital stay. Adcon-L (Gliatech, Inc., Cleveland, OH) (adhesion control in a barrier gel) has been demonstrated to act as a barrier to the development of epidural fibrosis after lumbar procedures, minimizing the formation of fibrotic scar and improving the long-term outcome. In this study, we used Adcon-L as a vehicle to administer 1 mg of morphine epidurally to patients who underwent lumbar microdiscectomy. Our objective was to evaluate the safety and analgesic efficacy of this compound . METHODS: A randomized, controlled, double-blind study was conducted in 100 patients. Patients were randomized to two groups: the morphine-Adcon-L (M-ADL) group (n = 51 patients) or the Adcon-L control group (n = 49 patients). Outcome measures included: 1) a visual analog scale to assess the intensity of spontaneous low back and radicular pain, 2) a straight leg-raising maneuver to assess the degree of leg elevation in relation to evoked sciatic pain, 3) postoperative time to comfortable walking, 4) duration of postoperative hospitalization, 5) required amount of postoperative analgesics, and 6) postoperative work time loss. RESULTS: No intraoperative or postoperative complications were observed. No clinically relevant adverse events, such as urinary retention, respiratory disturbances, or wound infections were reported in the M-ADL group. At the time of hospital discharge, results were as follows: 1) the M-ADL group had significantly lower pain intensity scores (mean value of postoperative visual analog scale, 12.3 mm ± 0.9 in the M-ADL group versus 24.7 mm ± 11.5 in the control group [P < 0.0001]); 2) the M-ADL group consumed significantly less analgesics: 57.4% of M-ADL patients versus 95.9% of controls received analgesics in the hospital, and 23.5% of M-ADL patients versus 55.1% of controls used analgesics at home (P < 0.0001); 3) the M-ADL group had significantly shorter hospital stays (1.37 ± 0.07 d versus 2.53 ± 0.12 d in the control group [P < 0.0001]); 4) the M-ADL group had a significantly higher degree of symptomatic leg elevation in the straight leg raising (mean postoperative straight leg-raising test, 64.41 degrees ± 1.59 versus 57.77 degrees ± 1.85 in the controls [P = 0.02]); and 5) the M-ADL group lost significantly less postoperative work time (21.67 ± 0.92 d versus 29.47 ± 1.18 d in the control group). In addition, at 1 year of follow-up, there was no clinical evidence of late-onset neurological complications. CONCLUSION: The epidural application of the compound M-ADL after lumbar microdiscectomy was found to be safe and effective, and it significantly improved postoperative pain control and return to function.

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Zhang, Xiaobo, Jie Zhang, Yun Liu, Dongming Zhu, Dong Chen, Zhen Zhang, and Yu Sun. "Pirfenidone inhibits fibroblast proliferation, migration or adhesion and reduces epidural fibrosis in rats via the PI3K/AKT signaling pathway." Biochemical and Biophysical Research Communications 547 (April 2021): 183–91. http://dx.doi.org/10.1016/j.bbrc.2021.01.055.

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Wang, Kun, Xiao long Li, Jinbo Liu, Xiaoliang Sun, Huilin Yang, and Xin Gao. "Using cross-linked hyaluronic acid gel to prevent postoperative lumbar epidural space adhesion: in vitro and in vivo studies." European Spine Journal 29, no. 1 (October 19, 2019): 129–40. http://dx.doi.org/10.1007/s00586-019-06193-w.

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Islamov, Rustem, Farid Bashirov, Andrei Izmailov, Filip Fadeev, Vage Markosyan, Mikhail Sokolov, Maksim Shmarov, Denis Logunov, Boris Naroditsky, and Igor Lavrov. "New Therapy for Spinal Cord Injury: Autologous Genetically-Enriched Leucoconcentrate Integrated with Epidural Electrical Stimulation." Cells 11, no. 1 (January 2, 2022): 144. http://dx.doi.org/10.3390/cells11010144.

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The contemporary strategy for spinal cord injury (SCI) therapy aims to combine multiple approaches to control pathogenic mechanisms of neurodegeneration and stimulate neuroregeneration. In this study, a novel regenerative approach using an autologous leucoconcentrate enriched with transgenes encoding vascular endothelial growth factor (VEGF), glial cell line-derived neurotrophic factor (GDNF), and neural cell adhesion molecule (NCAM) combined with supra- and sub-lesional epidural electrical stimulation (EES) was tested on mini-pigs similar in morpho-physiological scale to humans. The complex analysis of the spinal cord recovery after a moderate contusion injury in treated mini-pigs compared to control animals revealed: better performance in behavioural and joint kinematics, restoration of electromyography characteristics, and improvement in selected immunohistology features related to cell survivability, synaptic protein expression, and glial reorganization above and below the injury. These results for the first time demonstrate the positive effect of intravenous infusion of autologous genetically-enriched leucoconcentrate producing recombinant molecules stimulating neuroregeneration combined with neuromodulation by translesional multisite EES on the restoration of the post-traumatic spinal cord in mini-pigs and suggest the high translational potential of this novel regenerative therapy for SCI patients.

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Liu, Zhi-chen, Yang Li, Yuan Zang, Geng Cui, Hong-xun Sang, Zhen-sheng Ma, Liang Kong, Wei Lei, and Zi-xiang Wu. "Clinical assessment of a CMC/PEO gel to inhibit postoperative epidural adhesion formation after lumbar discectomy: a randomized, control study." Archives of Orthopaedic and Trauma Surgery 133, no. 3 (December 30, 2012): 295–301. http://dx.doi.org/10.1007/s00402-012-1634-0.

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Sugii, Narushi, Masahide Matsuda, Tomokazu Sekine, Hideaki Matsumura, Tetsuya Yamamoto, and Akira Matsumura. "Delayed Brain Edema and Swelling following Craniectomy for Evacuation of an Epidural Abscess that Improved by Cranioplasty: Case Report." Journal of Neurological Surgery Reports 78, no. 03 (July 2017): e109-e112. http://dx.doi.org/10.1055/s-0037-1606315.

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AbstractWe report a unique case of delayed brain swelling following craniectomy that improved rapidly after cranioplasty, and discuss the potential mechanism underlying this delayed and reversible brain swelling. A 22-year-old woman developed surgical site infection after removal of a convexity meningioma. Magnetic resonance imaging revealed an epidural abscess around the surgical site. Subsequently, the abscess was evacuated, and the bone flap was removed. Later, brain edema around the skull defect emerged and progressed gradually, despite resolution of the infection. The edematous brain developed focal swelling outward through the bone defect without ventricle dilatation. Because we suspected that the edema and swelling were caused by the state of the bone defect, we performed a cranioplasty 10 weeks after the bone flap removal, and brain edema improved rapidly. We hypothesized that the brain edema was initially caused by surgical stress and inflammation, followed by compression of cortical veins between the dural edge and brain tissue, leading to disruption of venous return and exacerbation of brain edema. When delayed focal brain edema and external swelling progress gradually after bone flap removal, after excluding other pathological conditions, cranioplasty should be considered to improve cortical venous congestion caused by postsurgical adhesion.

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Liu, Zhi-chen, Yang Li, Yuan Zang, Geng Cui, Hong-xun Sang, Zhen-sheng Ma, Liang Kong, Wei Lei, and Zi-xiang Wu. "Erratum to: Clinical assessment of a CMC/PEO gel to inhibit postoperative epidural adhesion formation after lumbar discectomy: a randomized, control study." Archives of Orthopaedic and Trauma Surgery 133, no. 6 (April 6, 2013): 881. http://dx.doi.org/10.1007/s00402-013-1732-7.

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Li, Chunbo, Hong Wang, Haifei Liu, Jingbo Yin, Lei Cui, and Zenggan Chen. "The prevention effect of poly (l-glutamic acid)/chitosan on spinal epidural fibrosis and peridural adhesion in the post-laminectomy rabbit model." European Spine Journal 23, no. 11 (July 8, 2014): 2423–31. http://dx.doi.org/10.1007/s00586-014-3438-0.

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Journal articles on the topic 'Epidural adhesion'

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