Effectiveness of a mucolythic agent as a local adjuvant in revision lumbar spine surgery

Chemically Assisted Dissection by Means of Mesna in Cholesteatoma Surgery

“…After trying different substances, we chose mesna, a synthetic sulfur compound that belongs to a class of thiol products already used in medicine for its mucolytic, antioxidant, and protective properties. Intraoperative use of mesna as a chemical dissector has been reported in different surgical fields such as gynecology, orthopedics, and otorhinolaryngology (14,21,22). Mesna was used by Yilmaz et al (23) to facilitate surgery in atelectatic ears and adhesive otitis Because retrospective studies can be biased by an irregular distribution of the patients in the study groups, we performed a statistical analysis that excluded significant differences between the 2 groups on the basis of the parameters of sex, age, cholesteatoma location and extension, ossicular chain lysis, erosion of the Fallopian canal, labyrinthine fistula, or bony defects of middle cranial fossa.…”

The grading model for the assessment of the total amount of epidural fibrosis in postoperative lumbar spine

“…Since the presence of EF makes surgical dissection difficult, lumbar revision surgery bears a high risk of intraoperative complications (e.g., bleeding, nerve root lesions, dural tears). To facilitate tissue dissection and entry into the spinal canal and to reduce the operative complications and surgical time, mucolytic agents for chemical dissection of EF have been developed [16]. In addition, some agents decrease not only the amount of EF, but also the tenacity of EF which makes lumbar revision surgery easier with fewer complications [17].…”

Epidural Fibrosis Seen from a Different Angle: Extraforaminal Lumbar Interbody Fusion

“…After muscle dissection and bone removal, fibroblasts descend from the periosteum and the paraspinal muscles, and invade the postoperative hematoma. 23 The hematoma is then organized and converted to granulation tissue and finally to epidural scar tissue. 24 The damage of the annulus fibrosus releases inflammation-mediating substances like interleukin 6 and 8 and tumor necrosis factor enclosed in the intervertebral disk that favor the development of scar tissue.…”

“…The resulting tethering and compression reduce mobility and may provoke mechanical or ischemic damage of neural and vascular structures when the spine moves. 11,23,24,32 Mechanical alterations of the spine like postoperative instability and sagittal plane deformity may also favor PEF formation. 4…”

“…The effect on clinical benefit, however, is debated, and its use is not without risks. 5,9,[33][34][35][36] A vast number of substances and materials acting as an adhesion barrier between the dura and the surrounding structures have been tested: nanofiber nets, 3 hyperbaric oxygen, 37 mesna, 23 hemostatic agents, 38 sodium hyaluronate, 39 viscous carboxymethylcellulose, 40 Gelfoam, 36 ADCON-L gel (Gliatech, Cleveland, Ohio, United States), [41][42][43] anti-adhesion gels, 27 Manuka honey, 12 mitomycin C, 44 morphine-vaseline sterile-oil, 45 medicated adhesion barrier, 46 and dehydrated human amnion/chorion membrane. 47 The use of some of the materials was restricted or related to complications.…”