Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of a Temperature-Sensitive, Anti-Adhesive Agent on the Reduction of Adhesion in a Rabbit Laminectomy Model

  • Park, Jeong Woo (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Bak, Koang Hum (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Cho, Tae Koo (Department of Neurosurgery, The Bone Spine & Joint Hospital Spine Center) ;
  • Chun, Hyoung-Joon (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Ryu, Je Il (Department of Neurosurgery, Hanyang University Guri Hospital)
  • Received : 2015.07.12
  • Accepted : 2015.12.21
  • Published : 2016.05.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : A common cause of failure in laminectomy surgery is when epidural, peridural, or perineural adhesion occurs postoperatively. The purpose of this study is to examine the efficacy of a temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG$^{(R)}$, as a mechanical barrier for the prevention or reduction of peridural scar adhesion in a rabbit laminectomy model. Methods : Twenty-six mature rabbits were used for this study. Each rabbit underwent two separate laminectomies at lumbar vertebrae L3 and L6, left empty (the control group) and applied 2 mL of the TSAA agent (the experimental group), respectively. Invasive scar formation or inflammation after laminectomy was quantitatively evaluated by measuring the thickness of the dura, the distance from the surface of dura to the scar tissues, the number of inflammatory cells in the scar tissues at the laminectomy site, and the concentration of collagen in histological sections. Results : At 6 weeks postsurgery, the dura was significantly thinner and the distance from the surface of dura to the scar tissues was greater in the experimental group than in the control group (p=0.04 and p=0.01). The number of inflammatory cells was not significantly different in the two groups (p=0.08), although the mean number of inflammatory cells was relatively lower in the experimental group than in the control group. Conclusion : The current study suggests that the TSAA agent, Guardix-SG$^{(R)}$, could be useful as an interpositional physical barrier after laminectomy for the prevention or reduction of adhesion.

Keywords

References

  1. Akeson WH, Massie JB, Huang B, Giurea A, Sah R, Garfin SR, et al. : Topical high-molecular-weight hyaluronan and a roofing barrier sheet equally inhibit postlaminectomy fibrosis. Spine J 5 : 180-190, 2005 https://doi.org/10.1016/j.spinee.2004.06.019
  2. Alkalay RN, Kim DH, Urry DW, Xu J, Parker TM, Glazer PA : Prevention of postlaminectomy epidural fibrosis using bioelastic materials. Spine (Phila Pa 1976) 28 : 1659-1665, 2003
  3. Asch HL, Lewis PJ, Moreland DB, Egnatchik JG, Yu YJ, Clabeaux DE, et al. : Prospective multiple outcomes study of outpatient lumbar microdiscectomy : should 75 to 80% success rates be the norm? J Neurosurg 96 (1 Suppl) : 34-44, 2002
  4. Atlas SJ, Deyo RA, Keller RB, Chapin AM, Patrick DL, Long JM, et al. : The Maine Lumbar Spine Study, Part II. 1-year outcomes of surgical and nonsurgical management of sciatica. Spine (Phila Pa 1976) 21 : 1777-1186, 1996 https://doi.org/10.1097/00007632-199608010-00011
  5. Atlas SJ, Deyo RA, Keller RB, Chapin AM, Patrick DL, Long JM, et al. : The Maine Lumbar Spine Study, Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine (Phila Pa 1976) 21 : 1787-1794; discussion 1794-1795, 1996 https://doi.org/10.1097/00007632-199608010-00012
  6. Bryant MS, Bremer AM, Nguyen TQ : Autogeneic fat transplants in the epidural space in routine lumbar spine surgery. Neurosurgery 13 : 367-370, 1983 https://doi.org/10.1227/00006123-198310000-00003
  7. Cauchoix J, Ficat C, Girard B : Repeat surgery after disc excision. Spine (Phila Pa 1976) 3 : 256-259, 1978 https://doi.org/10.1097/00007632-197809000-00011
  8. Choi MY, Auh SJ, Choi DG, Chang BL : Effect of ADCON-L on adjustable strabismus surgery in rabbits. Br J Ophthalmol 85 : 80-84, 2001 https://doi.org/10.1136/bjo.85.1.80
  9. Diamond MP, Wexner SD, diZereg GS, Korell M, Zmora O, Van Goor H, et al. : Adhesion prevention and reduction : current status and future recommendations of a multinational interdisciplinary consensus conference. Surg Innov 17 : 183-188, 2010 https://doi.org/10.1177/1553350610379869
  10. DiFazio FA, Nichols JB, Pope MH, Frymoyer JW : The use of expanded polytetrafluoroethylene as an interpositional membrane after lumbar laminectomy. Spine (Phila Pa 1976) 20 : 986-991, 1995 https://doi.org/10.1097/00007632-199505000-00002
  11. Einhaus SL, Robertson JT, Dohan FC Jr, Wujek JR, Ahmad S : Reduction of peridural fibrosis after lumbar laminotomy and discectomy in dogs by a resorbable gel (ADCON-L). Spine (Phila Pa 1976) 22 : 1440-1446; discussion 1446-1447, 1997 https://doi.org/10.1097/00007632-199707010-00003
  12. Foulkes GD, Robinson JS Jr : Intraoperative dexamethasone irrigation in lumbar microdiskectomy. Clin Orthop Relat Res (261) : 224-228, 1990
  13. Ganzer D, Giese K, Volker L, Pietzner U, Follak N, Merk H : Two-year results after lumbar microdiscectomy with and without prophylaxis of a peridural fibrosis using Adcon-L. Arch Orthop Trauma Surg 123 : 17-21, 2003 https://doi.org/10.1007/s00402-002-0455-y
  14. Gerszten PC, Moossy JJ, Bahri S, Kalend A, Martinez AJ : Inhibition of peridural fibrosis after laminectomy using low-dose external beam radiation in a rat model. Neurosurgery 44 : 597-602; discussion 602-603, 1999 https://doi.org/10.1097/00006123-199903000-00090
  15. Gill GG, Sakovich L, Thompson E : Pedicle fat grafts for the prevention of scar formation after laminectomy. An experimental study in dogs. Spine (Phila Pa 1976) 4 : 176-186, 1979 https://doi.org/10.1097/00007632-197903000-00016
  16. Hellebrekers BW, Trimbos-Kemper TC, Trimbos JB, Emeis JJ, Kooistra T : Use of fibrinolytic agents in the prevention of postoperative adhesion formation. Fertil Steril 74 : 203-212, 2000 https://doi.org/10.1016/S0015-0282(00)00656-7
  17. Hinton JL Jr, Warejcka DJ, Mei Y, McLendon RE, Laurencin C, Lucas PA, et al. : Inhibition of epidural scar formation after lumbar laminectomy in the rat. Spine (Phila Pa 1976) 20 : 564-570; discussion 579-580, 1995 https://doi.org/10.1097/00007632-199503010-00011
  18. Hong JH, Choe JW, Kwon GY, Cho DY, Sohn DS, Kim SW, et al. : The effects of barrier materials on reduction of pericardial adhesion formation in rabbits : a comparative study of a hyaluronan-based solution and a temperature sensitive poloxamer solution/gel material. J Surg Res 166 : 206-213, 2011 https://doi.org/10.1016/j.jss.2010.09.034
  19. Jiang ZL, Fletcher NM, Diamond MP, Abu-Soud HM, Saed GM : Hypoxia regulates iNOS expression in human normal peritoneal and adhesion fibroblasts through nuclear factor kappa B activation mechanism. Fertil Steril 91 : 616-621, 2009 https://doi.org/10.1016/j.fertnstert.2007.11.059
  20. Jonsson B, Stromqvist B : Repeat decompression of lumbar nerve roots. A prospective two-year evaluation. J Bone Joint Surg Br 75 : 894-897, 1993
  21. Kato T, Haro H, Komori H, Shinomiya K : Evaluation of hyaluronic acid sheet for the prevention of postlaminectomy adhesions. Spine J 5 : 479-488, 2005 https://doi.org/10.1016/j.spinee.2005.01.010
  22. Key JA, Ford LT : Experimental intervertebral-disc lesions. J Bone Joint Surg Am 30A : 621-630, 1948
  23. Kim DW, Chun HJ, Lee SK : Percutaneous needle puncture technique to create a rabbit model with traumatic degenerative disk disease. World Neurosurg 84 : 438-445, 2015 https://doi.org/10.1016/j.wneu.2015.03.066
  24. Kim SS, Michelsen CB : Revision surgery for failed back surgery syndrome. Spine (Phila Pa 1976) 17 : 957-960, 1992 https://doi.org/10.1097/00007632-199208000-00015
  25. Kwon SW, Lim SH, Lee YW, Lee YG, Chu BY, Lee JH, et al. : Anti-adhesive effect of poloxamer/alginate/CaCl2 mixture in the rat model. J Korean Surg Soc 71 : 280-287, 2006
  26. LaRocca H, Macnab I : The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg Br 56B : 545-550, 1974
  27. Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL : Peritoneal adhesions : etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg 18 : 260-273, 2001 https://doi.org/10.1159/000050149
  28. Liu S, Boutrand JP, Bittoun J, Tadie M : A collagen-based sealant to prevent in vivo reformation of epidural scar adhesions in an adult rat laminectomy model. J Neurosurg 97 (1 Suppl) : 69-74, 2002
  29. Massie JB, Schimizzi AL, Huang B, Kim CW, Garfin SR, Akeson WH : Topical high molecular weight hyaluronan reduces radicular pain post laminectomy in a rat model. Spine J 5 : 494-502, 2005 https://doi.org/10.1016/j.spinee.2004.12.003
  30. Nagakura T, Hirata H, Tsujii M, Sugimoto T, Miyamoto K, Horiuchi T, et al. : Effect of viscous injectable pure alginate sol on cultured fibroblasts. Plast Reconstr Surg 116 : 831-838, 2005 https://doi.org/10.1097/01.prs.0000176894.70848.98
  31. Neel HB 3rd : Implants of Gore-Tex. Arch Otolaryngol 109 : 427-433, 1983 https://doi.org/10.1001/archotol.1983.00800210003001
  32. North RB, Campbell JN, James CS, Conover-Walker MK, Wang H, Piantadosi S, et al. : Failed back surgery syndrome : 5-year follow-up in 102 patients undergoing repeated operation. Neurosurgery 28 : 685-690; discussion 690-691, 1991 https://doi.org/10.1227/00006123-199105000-00008
  33. Oh SH, Kim JK, Song KS, Noh SM, Ghil SH, Yuk SH, et al. : Prevention of postsurgical tissue adhesion by anti-inflammatory drug-loaded pluronic mixtures with sol-gel transition behavior. J Biomed Mater Res A 72 : 306-316, 2005
  34. Park JH, Jeong SH, Lee YJ, Choi SK, Hong SC, Jung EJ, et al. : Current status of the use of antiadhesive agents for gastric cancer surgery : a questionnaire survey in South Korea. J Korean Surg Soc 84 : 160-167, 2013 https://doi.org/10.4174/jkss.2013.84.3.160
  35. Park JS, Cha SJ, Kim BG, Choi YS, Kwon GY, Kang H, et al. : An assessment of the effects of a hyaluronan-based solution on reduction of postsurgical adhesion formation in rats : a comparative study of hyaluronan-based solution and two film barriers. J Surg Res 168 : 49-55, 2011 https://doi.org/10.1016/j.jss.2009.09.025
  36. Park SO, Han J, Minn KW, Jin US : Prevention of capsular contracture with Guardix-SG ((R)) after silicone implant insertion. Aesthetic Plast Surg 37 : 543-548, 2013 https://doi.org/10.1007/s00266-013-0087-3
  37. Reigel DH, Bazmi B, Shih SR, Marquardt MD : A pilot investigation of poloxamer 407 for the prevention of leptomeningeal adhesions in the rabbit. Pediatr Neurosurg 19 : 250-255, 1993 https://doi.org/10.1159/000120740
  38. Ross JS, Robertson JT, Frederickson RC, Petrie JL, Obuchowski N, Modic MT, et al. : Association between peridural scar and recurrent radicular pain after lumbar discectomy : magnetic resonance evaluation. ADCON-L European Study Group. Neurosurgery 38 : 855-861; discussion 861-863, 1996 https://doi.org/10.1227/00006123-199604000-00053
  39. Rout UK, Saed GM, Diamond MP : Expression pattern and regulation of genes differ between fibroblasts of adhesion and normal human peritoneum. Reprod Biol Endocrinol 3 : 1, 2005 https://doi.org/10.1186/1477-7827-3-1
  40. Saed GM, Diamond MP : Modulation of the expression of tissue plasminogen activator and its inhibitor by hypoxia in human peritoneal and adhesion fibroblasts. Fertil Steril 79 : 164-168, 2003 https://doi.org/10.1016/S0015-0282(02)04557-0
  41. Seifer DB, Diamond MP, DeCherney AH : An appraisal of barrier agents in the reduction of adhesion formation following surgery. J Gynecol Surg 6 : 3-10, 1990 https://doi.org/10.1089/gyn.1990.6.3
  42. Shih HN, Fang JF, Chen JH, Yang CL, Chen YH, Sung TH, et al. : Reduction in experimental peridural adhesion with the use of a crosslinked hyaluronate/collagen membrane. J Biomed Mater Res B Appl Biomater 71 : 421-428, 2004
  43. Shim HS, Lee YW, Lee YM, Oh YH, Kwon SW, Kim JH, et al. : Evaluation of resorbable materials for preventing surgical adhesion on rat experiment. J Korean Surg Soc 63 : 179-186, 2002
  44. Songer MN, Ghosh L, Spencer DL : Effects of sodium hyaluronate on peridural fibrosis after lumbar laminotomy and discectomy. Spine (Phila Pa 1976) 15 : 550-554, 1990 https://doi.org/10.1097/00007632-199006000-00022
  45. Songer MN, Rauschning W, Carson EW, Pandit SM : Analysis of peridural scar formation and its prevention after lumbar laminotomy and discectomy in dogs. Spine (Phila Pa 1976) 20 : 571-580; discussion 579-580, 1995 https://doi.org/10.1097/00007632-199503010-00012
  46. Temel SG, Ozturk C, Temiz A, Ersozlu S, Aydinli U : A new material for prevention of epidural fibrosis after laminectomy : oxidized regenerated cellulose (interceed), an absorbable barrier. J Spinal Disord Tech 19 : 270-275, 2006 https://doi.org/10.1097/01.bsd.0000203946.11546.d9
  47. Ward BC, Panitch A : Abdominal adhesions : current and novel therapies. J Surg Res 165 : 91-111, 2011 https://doi.org/10.1016/j.jss.2009.09.015
  48. Welch WC, Thomas KA, Cornwall GB, Gerszten PC, Toth JM, Nemoto EM, et al. : Use of polylactide resorbable film as an adhesion barrier. J Neurosurg 97 (4 Suppl) : 413-422, 2002
  49. Yong-Hing K, Reilly J, de Korompay V, Kirkaldy-Willis WH : Prevention of nerve root adhesions after laminectomy. Spine (Phila Pa 1976) 5 : 59-64, 1980 https://doi.org/10.1097/00007632-198001000-00011
  50. Young RL, Cota J, Zund G, Mason BA, Wheeler JM : The use of an amniotic membrane graft to prevent postoperative adhesions. Fertil Steril 55 : 624-628, 1991 https://doi.org/10.1016/S0015-0282(16)54197-1
  51. Yu CH, Lee JH, Baek HR, Nam H : The effectiveness of poloxamer 407-based new anti-adhesive material in a laminectomy model in rats. Eur Spine J 21 : 971-979, 2012 https://doi.org/10.1007/s00586-011-2098-6
  52. Zavala-Rodriguez JM, Correa Rovelo JM, Martinez-Morales N, Munoz-Arce C, Bobadilla-Lugo RA, Kross RD, et al. : Oxychlorine species suppress postsurgical adhesions in rats. J Surg Res 186 : 164-169, 2014 https://doi.org/10.1016/j.jss.2013.07.043

Cited by

  1. Effects of a Temperature-sensitive, Anti-adhesive Agent on the Clinical Outcome of Carpal Tunnel Release Surgery vol.23, pp.2, 2016, https://doi.org/10.12790/ahm.2018.23.2.126
  2. Temperature-sensitive anti-adhesive poloxamer hydrogel decreases fascial adhesion in total knee arthroplasty: A prospective randomized controlled study vol.34, pp.3, 2019, https://doi.org/10.1177/0885328219852890