The effectiveness of organic vegetable oils with high biocompatibility in preventing epidural fibrosis: An experimental study.

Background and purpose:

Epidural fibrosis after all spinal surgeries is an important surgical issue. Various biological and non-biological materials have been tried to inhibit epidural fibrosis, which is deemed to be the most important cause of pain after spinal surgery. Olive oil, nigella sativa oil and soybean oil employed in oral nutrition in clinics involving liquid fatty acids, palmatic acid, linoleic acid, stearic acid and palmitoleic acid. The effectiveness of olive oil, nigella sativa oil and soybean oil on epidural fibrosis was researched on for the first time in laminectomy model.

Fifty adult male Wistar albino rats weighing between 300 and 400 grams were used in the research. A total of 5 groups were formed: sham (Group I) (n = 10), no application was created; Group II (n = 10) 1 cc saline; Group III (n = 10) 1 cc olive oil; Group IV (n = 10) 1 cc nigella sativa oil; Group V (n = 10); 1 cc soybean oil was applied topically to the epidural region after laminectomy. The total spine of the rats was dissected, histopathological and immuno­chemical measurements were conducted. Neuro-histopathological results were scored semi-quantitatively in terms of vascular modification, neuron degeneration, gliosis and bleeding criteria.

The lowest level of fibrosis and connective tissue proliferation was observed in the group where nigella sativa oil was used after the operation, followed by the group treated with olive oil and lastly with the group given soybean oil.

Nigella sativa oil and olive oil are very efficient for lowering the degree of epidural fibrosis and adhesions following laminectomy and can be employed as a simple, inexpensive and highly biocompatible material in clinical practice.

Application of the novel Nalu™ Neurostimulation System for peripheral nerve stimulation.

Peripheral nerve stimulation is an established treatment modality for chronic neuropathic pain. Over the last decade, with the advent of innovative devices and delivery platforms, peripheral nerve stimulation has evolved from invasive open surgeries to image-guided, minimally invasive percutaneous procedures. The authors hereby present a novel device, the Nalu™ Neurostimulation System (Nalu Medical, CA, USA), which has established its advantages in providing predictable and reliable peripheral nerve stimulation therapy for chronic neuropathic pain management. This novel device is effective in treating chronic pain conditions such as post-herniorrhaphy pain syndrome, intercostal neuralgia, post-laminectomy syndrome, and complex regional pain syndrome and holds great promise for the treatment of peripheral neuropathic pain.

Chronic nerve pain is a debilitating condition that can affect quality of life and functioning. The Nalu™ Neurostimulation System (Nalu Medical, CA, USA) provides long-term pain relief without medications. There are numerous devices currently available that can be utilized to block pain signals using small wires. This system is unique because the wires placed over affected nerves are powered by an external battery that does not require permanent surgical implantation. Pain after hernia surgery, back surgery, hip surgery and knee surgery, as well as nerve pain can be effectively managed by this system.

Use of hypnosis preoperatively for surgery of the spine: Pilot study.

INTRODUCTION: Hypnosis is a technique requiring no drugs that acts during the three phases of surgery, reducing stress at the pre-surgical phase and the adminstration of anesthetic drugs during the intraoperative phase, as well as leading to improved management of postoperative pain and quality of life management. MATERIAL ET METHOD: We carried out a retrospective study of 46 patients operated on for herniated disc or one or two-level laminectomy without arthrodesis. All patients benefited from a preoperative hypnosis session and completed a questionnaire about their possible concerns. The day after surgery, patients completed a second questionnaire on their postoperative experience following hypnosis. RESULTATS: Our results indicate that this technique had a positive impact on the management of preoperative stress (80% of patients) and on postoperative quality of life (48% of patients). Pain measured by decreased from 4.8/10 preoperatively to 0.9/10 postoperatively. CONCLUSION: Our results are consistent with previous findings in the literature as to the positive contribution of this technique in the management of preoperative stress and patient quality of life. Further studies are however required involving considerably larger cohorts and more extensive surgeries to confirm the effect of this technique on management of anesthesia and pain in spine surgery.

Effect of Multimodal Drugs Infiltration on Postoperative Pain in Split Laminectomy of Lumbar Spine: A Randomized Controlled Trial.

STUDY DESIGN: A randomized, double-blinded controlled trial. OBJECTIVE: This study tested the effect of single-dose wound infiltration with multiple drugs for pain management after lumbar spine surgery. SUMMARY OF BACKGROUND DATA: Patients undergoing spine surgery often experience severe pain especially in early postoperative period. We hypothesized that intraoperative wound infiltration with multiple drugs would improve outcomes in lumbar spine surgery. METHODS: Fifty-two patients who underwent one to two levels of spinous process splitting laminectomy of lumbar spine, were randomized into two groups. Infiltration group received intraoperative wound infiltration of local anesthetics, morphine sulfate, epinephrine, and nonsteroidal anti-inflammatory drugs at the end of surgery, and received patient-controlled analgesia (PCA) postoperatively. The control group received only PCA postoperatively. The primary outcome measures were amount of morphine consumption and visual analogue scale (VAS) for pain. The secondary outcome measures were Oswestry Disability Index (ODI), Roland-Morris Low Back Pain and Disability Questionnaire (RMDQ), patient satisfaction, length of hospital stay, and side effects. RESULTS: A total of 49 patients (23 patients for local infiltration group, and 26 patients for control group) were analyzed. There were statistically significant [P < 0.001, the effect size -5.0, 95% CI (-6.1, -3.9)] less morphine consumptions in the local infiltration group than the control group during the first 12 hours, 12 to 24 hours, and 24 to 48 hours after surgery. The VAS of postoperative pain reported by patients at rest and during motion was significantly lower in the local infiltration group than the control group at all assessment times (P < 0.001). The effect size of VAS of postoperative pain at rest and during motion were -2.0, 95% CI (-2.5, -1.4) and -2.0, 95% CI (-2.6, -1.4) respectively. ODI and RMDQ at 2 week and 3 month follow-ups in both groups had significant improvement from baseline (P < 0.001). No significant differences were found between groups (P = 0.262 for ODI and P = 0.296 for RMDQ). There were no significant differences of patient satisfaction, length of stay, and side effects between both groups (P = 0.256, P = 0.262, P = 0.145 respectively). CONCLUSION: Intraoperative wound infiltration with multimodal drugs reduced postoperative morphine consumption, decreased pain score with no increased side effects. LEVEL OF EVIDENCE: 1.

Preemptive Infiltration with Betamethasone and Ropivacaine for Postoperative Pain in Laminoplasty or Laminectomy (PRE-EASE): study protocol for a randomized controlled trial.

BACKGROUND: Laminoplasty and laminectomy have been used for decades for the treatment of intraspinal space-occupying lesions, spinal stenosis, disc herniation, injuries, etc. After these procedures, patients often experience severe postoperative pain at the surgical site. Intense immediate postoperative pain after many spinal procedures makes its control of utmost importance. Preemptive injection of local anesthetics can significantly reduce postoperative pain during rest and movement; however, the analgesic effect is only maintained for a relatively short period of time. Whether betamethasone combined with local anesthetic for laminoplasty or laminectomy has better short-term and long-term effects than the local anesthetic alone has not been reported yet. METHODS: The PRE-EASE trial is a prospective, randomized, open-label, blinded endpoint, single-center clinical study including 116 participants scheduled for elective laminoplasty or laminectomy, with a 6 months' follow-up process. Preemptive local infiltration with betamethasone and ropivacaine (treatment group) or ropivacaine alone (control group) throughout the entire thickness of the planned incision site will be performed by the surgeon prior to making the incision. The primary outcome will be the cumulative butorphanol consumption within the first 48-h postoperative period. DISCUSSION: This study will add significant new knowledge to the effect and feasibility of preemptive local infiltration of betamethasone for postoperative pain management in laminoplasty and laminectomy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04153396. Registered on 6 November 2019.

The Treatment of Perioperative Spinal Cord Injury With Hyperbaric Oxygen Therapy: A Case Report.

STUDY DESIGN: Case report (level IV evidence). OBJECTIVE: To describe a potential novel application of hyperbaric oxygen therapy (HBOT) in the successful treatment of a postoperative spinal cord injury. SUMMARY OF BACKGROUND DATA: A 68-year-old man presented with an acute spinal cord injury (ASIA impairment scale D), on the background of degenerative lower thoracic and lumbar canal stenosis. He underwent emergent decompression and instrumented fusion (T9-L5), with an uncomplicated intraoperative course and no electrophysiological changes. Immediate postoperative assessment demonstrated profound bilateral limb weakness (1/5 on the Medical Research Council [MRC] grading scale, ASIA impairment scale B), without radiological abnormality. METHODS: Conventional medical management (hypertension, level 2 care) was instigated with the addition of Riluzole, with no effect after 30 hours. At 36 hours 100% oxygen at 2.8 atmospheres was applied for 90 minutes, and repeated after 8 hours, with a further three treatments over 48 hours. RESULTS: The patient demonstrated near-immediate improvement in lower limb function to anti-gravity (MRC grading 3/5) after one treatment. Motor improvement continued over the following treatments, and after 2 weeks the patient was ambulatory. At 4 months, the patient demonstrated normal motor function with no sphincteric disturbance. CONCLUSION: The application of HBOT contributed to the immediate and sustained improvement (ASIA B to ASIA E) in motor recovery after postoperative spinal cord injury. HBOT may represent a new avenue of therapy for spinal cord injury, and requires further prospective investigation. LEVEL OF EVIDENCE: 4.

Emodin promotes fibroblast apoptosis and prevents epidural fibrosis through PERK pathway in rats.

BACKGROUND: Laminectomy is usually classed as a common orthopedic surgery, but postoperative epidural fibrosis often leads to less-than-desirable clinical outcomes. As demonstrated by prior studies, emodin (EMO) exerts an anti-fibrotic effect. Here, we carried out investigation into the inhibitory effect created by EMO application on epidural fibrosis after laminectomy in rats. METHODS: The paper conducts a series of experiment. In vitro, we observed the effect of EMO on fibroblasts by Cell Counting Kit-8 (CCK-8) assay. Apoptosis of fibroblasts induced by EMO was detected by western blot, TUNEL assay, and flow cytometry. The results revealed that EMO was capable of inducing fibroblast apoptosis, and the proteins of PERK pathway also changed accordingly. In vivo, the effect of EMO on epidural fibrosis in 12 male Sprague-Dawley rats was observed by histological staining. RESULTS: CCK-8 assay indicated that EMO was effective in reducing fibroblast viability in a time- and a dose-dependent manner. TUNEL assay and flow cytometry analysis have demonstrated that the apoptotic rate of fibroblasts increased as the EMO concentration rose. Western blot analysis proved that EMO promoted the relative expression of p-perk and p-eIF2α and that the expression of its downstream proteins CHOP and GRP78 was also enhanced. The expression of apoptotic protein Bax and cleaved PARP was upregulated, whereas the expression of anti-apoptotic protein Bcl-2 was downregulated. In addition, histological and immunohistochemical analysis demonstrated that EMO functioned to inhibit epidural fibrosis and increase GRP78 expression in fibrous tissue by promoting apoptosis of fibroblasts. CONCLUSIONS: EMO could have inhibitory effect on epidural fibrosis in a concentration-dependent manner. The potential mechanism might be through PERK signaling pathway to promote fibroblast apoptosis. It has a possibility to be taken as a novel method for the treatment of epidural fibrosis.

Artesunate inhibits fibroblasts proliferation and reduces surgery-induced epidural fibrosis via the autophagy-mediated p53/p21waf1/cip1 pathway.

Fibroblast proliferation is considered to be a major cause in the process of epidural fibrosis formation. Autophagy is a tightly-regulated catabolic process in charge of degrading intracellular components. Although autophagy has been associated with fibrosis of different tissues, the effect of autophagy on epidural fibrosis is still unknown. The aim of this study was to investigate the function and mechanism of autophagy induced by Artesunate (ART), a classical antimalarial agent extracted from the Chinese medicinal herb. In vitro, the effect of ART on inducing fibroblast autophagy was evaluated via LC3 immunofluorescent staining, Transmission Electron Microscopy (TEM) and western blotting analysis. Moreover, the effect of ART on inhibiting fibroblast proliferation was investigated by CCK-8 assay, EdU incorporation assay, flow cytometry and western blotting analysis. Results indicated that ART could induce autophagy and inhibit proliferation in fibroblasts. The inhibitory effect of ART on fibroblast proliferation was associated with the upregulation of p53 and p21waf1/cip1 proteins. Intriguingly, 3-MA, a classical autophagy inhibitor, attenuated ART-induced p53/p21waf1/cip1 pathway activation and fibroblast proliferation inhibition. In vivo, the effect of ART on reducing epidural fibrosis was detected by histological macroscopic assessment, hydroxyproline content analysis, histological and immunohistochemical staining. The results revealed that ART had significant suppressive effects on epidural fibrosis following laminectomy in rats. In conclusion, this research demonstrated that ART could inhibit fibroblast proliferation and reduce epidural fibrosis formation after laminectomy, and the potential mechanism might through autophagy cascade-mediated p53/p21waf1/cip1 pathway. It might provide a novel reagent for reducing epidural fibrosis after spinal laminectomy surgery.

Sensorineural hearing loss after spine surgery treated with hyperbaric oxygen therapy: two case reports.

Acute idiopathic sudden sensorineural hearing loss (ISSNHL) following lumbar spinal surgery is an exceedingly rare phenomenon. This paper presents a case of ISSNHL presenting acutely after lumbar spine decompression and fusion treated with transtympanic steroids and hyperbaric oxygen (HBO2) therapy. It also presents the ironic case of SSNHL secondary to presumed viral pathology sustained by the patient's operative surgeon who was treated with transtympanic steroids and HBO2 as well. Proposed etiologies of the patient's ISSNHL include: hypotension, prone operative position, malfitted/malpositioned headrest, microemboli from a cell-saver, and nitrous oxide anesthesia. The role of systemic hypotension as an etiology of ISSNHL is discussed given the fact that there are no reported cases of ISSNHL in orthopedic procedures performed with permissive hypotension. The initiation of steroids and HBO2 therapy has been shown to be an effective treatment for ISSNHL when started within 14 days of symptom onset. HBO2 and transtympanic steroids were initiated 10 days earlier in the operative surgeon, which showed to be a better treatment modality compared to the postoperative patient. ISSNHL in the acute postoperative period of lumbar spinal fusion surgery presents a unique treatment dilemma because systemic steroids are routinely avoided over concerns of pseudarthrosis. Of the seven documented cases of ISSNHL following lumbar spine surgery, none underwent HBO2 as a treatment modality.

Effects of Ultra-early Hyperbaric Oxygen Therapy on Femoral Calcitonin Gene-Related Peptide and Bone Metabolism of Rats With Complete Spinal Transection.

STUDY DESIGN: Seventy-five Sprague-Dawley rats were randomly divided into sham, complete spinal cord transection (CSCT) and hyperbaric oxygen (HBO) groups. Among them, rats in HBO group were further divided into 3 hours group (HBO1) and 12 hours group (HBO2). OBJECTIVE: To study the effects of ultra-early HBO therapy on femoral calcitonin gene-related peptide (CGRP) and bone metabolism of rats with CSCT. SUMMARY OF BACKGROUND DATA: Complete spinal cord injury (SCI) is still an unresolved problem in clinical practice. Studies on changes in (calcitonin gene-related peptide) CGRP and bone metabolism and osteoporosis prevention after SCI have important clinical significance. METHODS: Rats in the sham group underwent laminectomy alone, whereas rats in the other three groups underwent laminectomy and CSCT at the level of the 10th thoracic vertebra. Six weeks after operation, rat blood samples and femoral samples from CSCT area were taken and prepared for immunohistochemical staining of CGRP, quantitative polymerase chain reaction (qPCR) of CGRP mRNA, enzyme-linked immunosorbent assay (ELISA) for the levels of serum bone-specific alkaline phosphatase (sBAP), serum osteocalcin (sOC), serum type-I collagen amino-terminal peptide (sNTX), and urinary deoxypyridinoline (uDPD). These data were statistically analyzed using paired LSD or Tamhane. RESULTS: The number of CGRP-positive cells and expression of CGRP mRNA in femur were significantly reduced, and the levels of sBAP, sOC, sNTX, and uDPD were significantly increased in CSCT, HBO1, and HBO2 groups than in the sham group, (P < 0.05-0.01). In addition, the number of CGRP-positive cells, expression of CGRP mRNA in femur, and the levels of sBAP and sOC were significantly enhanced, but the levels of sNTX and uDPD were significantly lowered in HBO1 group than in HBO2 and CSCT groups (P < 0.05). CONCLUSION: Ultra-early HBO therapy could improve bone turnover, promote bone formation, and prohibit bone resorption by enhancing CGRP synthesis in the sensory neurons in posterior horn of spinal cord. LEVEL OF EVIDENCE: N/A.

The Effect of Ankaferd Blood Stopper? on Epidural Fibrosis After Laminectomy in Rats: An Experimental Study.

AIM: Lumbar epidural fibrosis is increasingly recognized as a cause of persistent back pain. The aim of this study was to examine the effect Ankaferd Blood Stopper on epidural fibrosis following laminectomy in rat models. MATERIAL AND METHODS: Twenty Sprague-Dawley male rats were randomly allocated to 2 groups of 10 each. The dura mater and nerve root were exposed after L1 unilateral laminectomy. Close attention was paid not to traumatize the dura, the nerve roots, or the dissected muscles. Immediate muscle and skin closure was made in sham group. In the Ankaferd Blood Stopper group, cotton wool soaked with 1 mL Ankaferd Blood Stopper was applied to the exposure site for 5 minutes, and muscle and skin closure was then made. Histological analysis was performed at four weeks postoperatively. RESULTS: Epidural fibrosis formation evaluation and fibroblastic activity evaluation revealed that there was a significant difference between the sham and the Ankaferd Blood Stopper treated groups (p = 0.011, p = 0.009). Severe epidural adhesions were observed in the Ankaferd Blood Stopper group. Dissection of these epidural adhesions was difficult and accompanied by bleeding and disruption of the dura mater. CONCLUSION: The results of this study showed that there was no positive effect of Ankaferd Blood Stopper on the prevention of epidural fibrosis, which is one of the most significant problems following spinal surgery, and the epidural fibrosis actually increased.

Postlaminectomy Bone and Scar Formations in Presence of Ankaferd Blood Stopper and Bitter Melon (Momordica Charantia): An Experimental Study.

AIM: A quantitative model of postlaminectomy was designed in rats. The effects of Momordica Charantia (MC) and Ankaferd blood stopper (ABS) on the bone and scar formation after laminectomy were concurrently evaluated. MATERIAL AND METHODS: Eighteen adult Wistar albino rats underwent lumbar laminectomy at L2-L3 vertebral levels, and were randomly assigned to one of three groups of six rats each. The Treatment group received MC and ABS treatment and the Control group was left untreated. Rats were sacrificed 4 weeks after treatment. Then; the lumbar spine was excised en-block, fixed and decalcified. Sections were stained with hematoxylin and eosin (H&E) and Masson"s trichrome, and evaluated for peridural fibrosis (PF), new bone formation, and vascular proliferation. RESULTS: Total volume of new bone in the MC group was significantly increased in comparison to the Control group (p < 0.05). Also; there was highly significant increase in terms of the total volume of fibrous tissue in the MC and ABS groups when compared with the Control group (p < 0.01). Besides; there was a highly significant difference between the MC and the Control groups (p < 0.01) in point of total volume of vessel. CONCLUSION: Both MC and ABS are not convenient to prevent the PF formation and MC may promote new bone formation and angiogenesis after lumbar laminectomy in rats.

Ibuprofen-conjugated hyaluronate/polygalacturonic acid hydrogel for the prevention of epidural fibrosis.

The formation of fibrous tissue is part of the natural healing response following a laminectomy. Severe scar tissue adhesion, known as epidural fibrosis, is a common cause of failed back surgery syndrome. In this study, by combining the advantages of drug treatment with a physical barrier, an ibuprofen-conjugated crosslinkable polygalacturonic acid and hyaluronic acid hydrogel was developed for epidural fibrosis prevention. Conjugation was confirmed and measured by 1D(1)H NMR spectroscopy.In vitroanalysis showed that the ibuprofen-conjugated polygalacturonic acid-hyaluronic acid hydrogel showed low cytotoxicity. In addition, the conjugated ibuprofen decreased prostaglandin E2production of the lipopolysaccharide-induced RAW264.7 cells. Histological data inin vivostudies indicated that the scar tissue adhesion of laminectomized male adult rats was reduced by the application of our ibuprofen-conjugated polygalacturonic acid-hyaluronic acid hydrogel. Its use also reduced the population of giant cells and collagen deposition of scar tissue without inducing extensive cell recruitment. The results of this study therefore suggest that the local delivery of ibuprofenviaa polygalacturonic acid-hyaluronic acid-based hydrogel reduces the possibility of epidural fibrosis.

The effects of ankaferd blood stopper and microporous polysaccharide hemospheres on epidural fibrosis in rat laminectomy model

ABSTRACT PURPOSE: To investigate whether topically administered hemostatic agents ankaferd blood stopper and microporous polysaccharide hemospheres can decrease epidural fibrosis after laminectomy in rats. METHODS: Eighteen adult male Sprague-Dawley rats were equally and randomly divided into three groups. In the treatment groups, ankaferd blood stopper and microporous polysaccharide hemospheres topically administrated upon duramater surface after laminectomy. Fibroblast count, epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Our data revealed that the count of fibroblasts, the grading of epidural fibrosis and arachnoideal involvement in the rats treated with microporous polysaccharide hemospheres were significantly less than the control group. Although the arachnoideal involvement in ankaferd blood stopper group were significantly less than the control group, there were no statistical differences when comparing the grading of epidural fibrosis and the fibroblasts count between the treatment groups and the control group. CONCLUSION: The ankaferd blood stopper and microporous polysaccharide hemospheres reduced epidural fibrosis and arachnoideal involvement after laminectomy in rats.

Moving without moving: immediate management following lumbar spine surgery using a graded motor imagery approach: a case report.

Representational body maps are dynamically maintained in the brain and negatively influenced by neglect, decreased movement and pain. Graded motor imagery (GMI) utilizing various tactile and cognitive processes has shown efficacy in decreasing pain, disability and movement restrictions in musculoskeletal pain. Limited information is known about the cortical changes patients undergo during lumbar surgery (LS), let alone the therapeutic effect of GMI for LS. A 56-year-old patient underwent LS for low back pain, leg pain and progressive neurological deficit. Twenty-four hours prior to and 48 h after LS various psychometric, physical movement and tactile acuity measurements were recorded. Apart from predictable postoperative increases in pain, fear-avoidance, disability and movement-restrictions, pressure pain thresholds (PPT), two-point discrimination (TPD) and tactile acuity was greatly reduced. The patient underwent six physiotherapy (PT) treatments receiving a GMI program aimed at restoring the PPT, TPD and tactile acuity. The results revealed that GMI techniques applied to a patient immediately after LS caused marked improvements in movement (flexion average improvement/session 3.3 cm; straight leg raise average 8.3°/session) and an immediate hypoalgesic effect. GMI may provide PT with a non-threatening therapeutic treatment for the acute LS patient and establish a new role for PT in acute LS patients.

The effects of ankaferd blood stopper and microporous polysaccharide hemospheres on epidural fibrosis in rat laminectomy model.

PURPOSE: To investigate whether topically administered hemostatic agents ankaferd blood stopper and microporous polysaccharide hemospheres can decrease epidural fibrosis after laminectomy in rats. METHODS: Eighteen adult male Sprague-Dawley rats were equally and randomly divided into three groups. In the treatment groups, ankaferd blood stopper and microporous polysaccharide hemospheres topically administrated upon duramater surface after laminectomy. Fibroblast count, epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Our data revealed that the count of fibroblasts, the grading of epidural fibrosis and arachnoideal involvement in the rats treated with microporous polysaccharide hemospheres were significantly less than the control group. Although the arachnoideal involvement in ankaferd blood stopper group were significantly less than the control group, there were no statistical differences when comparing the grading of epidural fibrosis and the fibroblasts count between the treatment groups and the control group. CONCLUSION: The ankaferd blood stopper and microporous polysaccharide hemospheres reduced epidural fibrosis and arachnoideal involvement after laminectomy in rats.

Intraoperative powdered vancomycin use with paddle lead placement.

OBJECTIVES: This is a prospective case-control study that was conducted to determine if the addition of intraoperative powdered vancomycin placed directly into the wounds at the time of closure might decrease the rate of acute postoperative infection after the placement of spinal cord stimulator paddle leads. MATERIALS AND METHODS: A retrospective analysis of the author's practice from January 1, 2009 through July 31, 2012 (Table 1) showed that those patients requiring a laminectomy instead of a laminotomy to insert a paddle lead had an increased rate of acute postop infection. All patients receiving a thoracic spinal cord stimulator paddle from January 1, 2013 through December 31, 2013 were then followed prospectively. Those patients whose paddle leads could be inserted with a laminotomy were treated in a standard fashion. Those patients who required a laminectomy for insertion of the paddle lead received powdered vancomycin placed directly into the wounds prior to closure. RESULTS: One hundred and nine patients underwent implantation of a permanent spinal cord stimulator paddle lead and battery between January 1 and December 31, 2013. Thirty-two of those patients required a laminectomy for implantation of the paddle and received intraoperative powdered vancomycin placed directly into both wounds at the time of closure. The remaining 77 patients were treated in a standard fashion. There were no infections in the laminectomy group and two infections in the laminotomy group. CONCLUSION: This study indicates that intraoperative powdered vancomycin placed directly into the wounds at the time of closure can produce similar infection rates between the groups of patients requiring a laminectomy vs. a laminotomy for implantation of a thoracic paddle lead. These findings need confirmation by a randomized controlled design study.

An experimental novel study: hyperbaric oxygen treatment on reduction of epidural fibrosis via down-regulation of collagen deposition, IL-6, and TGF-ß1.

OBJECTIVE: To investigate the effect of hyperbaric oxygen treatment (HBO) on prevention of epidural fibrosis in laminectomy rats. METHODS: A controlled, double-blinded study was performed in sixty healthy adult Wistar rats, mean weight 250 g. L1-L2 levels laminectomy were performed. Randomly, all rats were divided into three groups, with 20 in each group: (1) short-term HBO treatment group; (2) long-term HBO treatment (LHBO) group; and (3) Sham group (laminectomy without treatment). Four weeks post-operation, all rats were killed. The Rydell classification, hydroxyproline content, vimentin cells density, capillary density, and inflammatory factors expression were evaluated. RESULTS: The histological evaluation showed less epidural scar adhesions in LHBO group than other two groups. The hydroxyproline content, Rydell score, vimentin cells density, capillary density, and inflammatory factors expression all suggested better results in LHBO group than other two groups. CONCLUSION: It was concluded that HBO treatment might be beneficial in inhibiting collagen deposition and inflammatory activity and prevent epidural scar adhesion in laminectomy rat and, therefore, shows potential for clinical use.

Study on salvianolic acid B in the reduction of epidural fibrosis in laminectomy rats.

BACKGROUND: Epidural fibrosis (EF) is a common complication after laminectomy. Salvianolic acid B (Sal B) is a major bioactive component of a traditional Chinese medical agent, Salvia miltiorrhiza, which has shown anti-inflammatory, anti-fibrotic and anti-proliferative properties. The object of this study was to investigate the effect of Sal B on the prevention of epidural fibrosis in laminectomy rats. METHODS: A controlled double-blinded study was conducted in sixty healthy adult Wistar rats that underwent laminectomy at the L1-L2 levels. The rats were randomly divided into 3 groups of 20: (1) Sal B treatment group; (2) Vehicle group; (3) Sham group (laminectomy without treatment). All rats were sacrificed 4 weeks post-operatively. The extent of epidural fibrosis, fibroblast proliferation and the expression of vascular endothelial growth factor (VEGF) and inflammatory factors were analyzed. RESULTS: The recovery of all rats was uneventful. In the laminectomy sites treated with Sal B, the dura mater showed no adhesion. Collagen deposition was significantly lower in the Sal B group than the other two groups. In addition, both fibroblast and inflammatory cell counting in the laminectomy sites treated with Sal B showed better grades than the other two groups. The expression of VEGF and inflammatory factors in operative sites also suggested better results in the Sal B group than the other two groups. CONCLUSIONS: Sal B inhibits fibroblast proliferation, blood vessel regeneration, and inflammatory factor expression. Thus, Sal B is able to prevent epidural scar adhesion in post-laminectomy rats.

Tissue-engineered bone formation in vivo for artificial laminae of the vertebral arch using ß-tricalcium phosphate bioceramics seeded with mesenchymal stem cells.

STUDY DESIGN: A rabbit laminectomy model was used to evaluate the efficacy of artificial laminae of vertebral arch using bone marrow-derived mesenchymal stem cells (MSCs) transplanted in porous beta-calcium phosphates (ß-TCP) bioceramics. OBJECTIVE: The aim of this study was to establish artificial lamina of the vertebral arch for bone tissue engineering using ß-TCP bioceramics seeded with MSCs in a rabbit model of decompressive laminectomy. SUMMARY OF BACKGROUND DATA: Decompressive laminectomy may induce various degrees of scar tissue and adhesion formation in the epidural space, and thus is the most common cause of failed back surgery syndrome. However, there is no effective method of bone defect treatment to control and reduce the scar tissue formation. METHODS: MSCs were harvested from New Zealand rabbits (2-week old) by femoral bone marrow extraction. These cells were seeded into porous ß-TCP bioceramics and cultivated for up to 3 weeks in the presence of osteogenic supplements. Segmental defects (20 × 8 mm) were created in 48 adult New Zealand rabbits that underwent laminectomy at the L5 to L6 levels. The animals were transplanted with cell media (control), ß-TCP bioceramics (group I), or MSC-loaded ß-TCP bioceramics (group II). Bone formation was evaluated after operation using scanning electron microscopy, computed tomography, magnetic resonance imaging, histomorphometry, and immunohistochemistry. RESULTS: Scanning electron microscopy showed that MSCs filled the pores and surfaces of bioceramics in MSC-loaded ß-TCP. In addition, significant increases in bone formation were observed in group II compared with other groups. Computed tomography and magnetic resonance imaging at 16 weeks showed that the artificial lamina of the vertebral arch was successfully formed. Hematoxylin-eosin and Masson trichrome staining were used to show the artificial laminae of the vertebral arch and the degraded bioceramics. In addition, immunohistochemistry results showed that the expression of bone morphogenetic protein-2 increased significantly in group II compared with group I at 2,4, and 8 weeks after implantation (P < 0.05). CONCLUSION: ß-TCP bioceramics seeded with MSCs are a promising source of tissue-engineered bone for the artificial lamina of the vertebral arch.