Anti-adhesive effect of hyaluronate in a rabbit laminectomy model

Abstract

P ostoperative fibrosis after spinal surgeries such as discectomy and laminectomy can sometimes cause neurologic side effects due to direct compression of the nerves by the surrounding structures or by the formation of adhesion between tissues, tethering the nerve roots and dural sac. Previous studies have investigated the close Original Article At a Glance Commentary Scientific background of the subjectHyaluronic acid has been widely used in numerous clinical applications. It has been used to treat knee osteoarthritis by injecting it into the joint. It can act as an anti-adhesion barrier in preventing postoperative scar tissue formation in various surgical procedures such as myomectomy and laparotomy. What this study adds to the fieldHyaluronic acid-based gel is effective in decreasing the tenacity of adhesion between the dura and scar and the amount of scar tissues after laminectomy in a rabbit model, which can be considered as a potential anti-adhesion barrier in preventing postoperative adhesion formation.Background: Postlaminectomy dural adhesion is a common cause of recurrent symptoms. Hyaluronic acid-based gel has been reported to reduce the incidence of postoperative adhesion in the peritoneal cavity; however, its effect on preventing postoperative scar formation at laminectomy sites is not yet known. The purpose of this study was to evaluate the anti-adhesive effect of hyaluronic acid-based gelatin after laminectomy, using a rabbit model. Methods:Twelve adult New Zealand rabbits underwent two-level lumbar laminectomy, and were randomly assigned to one of two groups of six rabbits each. The treatment group received hyaluronic acid-based gelatin treatment and the control group was untreated. Rabbits were sacrificed 8 weeks after treatment. Peel-off testing and histological analysis were performed to assess the tenacity and the extent of adhesion formation. Results:No significant difference was observed in the neurologic performance between the two groups. The tenacity in the treatment group was significantly reduced compared to that of the control group (3.17 ± 0.75 vs. 4.33 ± 0.52, respectively; p = 0.016). Histological analysis showed significantly less scar tissue formation in the treatment group, with a larger subarachnoid space and greater distance between the dura and scar tissues. The amount of fibroblast cells also was significantly smaller in the treatment group than in the control group (3078 ± 313.68 vs. 3742 ± 455.65, respectively; p = 0.042). Conclusions: No serious adverse events were reported, and no difference was found in the incidence of complications between the treatment and control groups. The findings suggested that hyaluronic acid-based gelatin may be effective for preventing postlaminectomy dural adhesion in rabbits. (Biomed J 2014;37:218-224)