Failure of Autologous Fat Grafts to Prevent Postoperative Epidural Fibrosis in Surgery of the Lumbar Spine

Martín-Ferrer, S.

doi:10.1227/00006123-198905000-00010

Cited by 48 publications

(5 citation statements)

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“…[60][61][62][63][64][65][66] An increase in adnexal adhesion score category indicates a worse prognosis for pregnancy. Prognostic categories for minimal (score, 0-5), mild (6-10), moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and severe (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) scores are provided for each patient group (Table II). The number of individual adnexal adhesion scores (Table IIIA) that improved or stayed the same from first-to second-look laparoscopy versus those that worsened reveals a significant treatment benefit from the use of peritoneal formulation (87 vs. 32% respec-tively; p < 0.01).…”

Section: Results Of the Peritoneal Formulation Europeanmentioning

confidence: 99%

“…Fibrosis can form between spinal dura mater and interposing structures as a result of hematoma or residual necrotic tissue, including fat. [16][17][18] It was reported that fewer than one-third of patients who undergo a repeated operation after lumbar disc surgery show persistent improvement of their symptoms; the chance of long-term surgical success after a repeated operation may be diminished in cases in which epidural fibrosis is prevalent. 18,19 Repeat surgery for epidural fibrosis is often less successful and may require prolonged operating time and increased risks of adhesive arachnoiditis and dural tears from surgery to treat fibrosis at the surgical site.…”

Section: Introductionmentioning

confidence: 99%

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A modern biomaterial for adhesion prevention

et al. 2006

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A biomaterial composed of carboxymethylcellulose, poly(ethylene oxide), and calcium can be prepared in a variety of ways to reduce fibrin deposition and adhesion formation. This biomaterial platform can be formulated into a flowable gel with tissue adherence appropriate for use in minimally invasive surgery. The device remains at the site of placement even in gravitationally dependent areas. A peridural formulation was shown in preclinical studies to be safe and effective in reducing adhesions to dura following spinal surgery. A peritoneal formulation used on pelvic organs following peritoneal cavity surgery was also shown to be safe and effective. A clinical feasibility study showed that patients with severe back pain and lower extremity weakness treated with the peridural formulation, applied over their nerve roots following laminectomy or laminotomy, experienced significantly reduced symptoms when compared with surgery-only controls. The peritoneal formulation was shown in two multicenter feasibility studies of women undergoing pelvic surgery to significantly reduce adhesion formation when compared with surgery-only controls. Confirmation of the feasibility studies awaits results from pivotal clinical trials. These formulations were safe, effective, and easy to use. This biomaterial provided a benefit to patients undergoing surgery where postsurgical adhesion formation is a concern.

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Section: Results Of the Peritoneal Formulation Europeanmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A modern biomaterial for adhesion prevention

et al. 2006

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“…Compression of nerve tissue can induce clinical symptoms such as numbness, pain, and muscle weakness. [ 7 8 ] Recently, many materials including silastic, Dacron, methacrylate, synthetic foam, elastase, etc. have been evaluated to prevent peridural scar with no clear documentation of beneficial results.…”

Section: Discussionmentioning

confidence: 99%

Epidural scarring after lumbar disc surgery: Equivalent scarring with/without free autologous fat grafts

Dobran¹,

Brancorsini²,

Costanza³

et al. 2017

Surg Neurol Int

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Background:To limit epidural fibrosis and prevent scar formation/nerve tethering that may contribute to chronic postoperative pain; some surgeons have utilized epidural autologous fat grafts following lumbar microdiscectomy.Methods:We investigated the correlation between post-microdiscectomy epidural scarring [including select magnetic resonance imaging (MRI) studies] and clinical outcomes in 36 patients operated for symptomatic. MRI documented L4-L5 and L5-S1 disk herniations with (18 patients) and without (18 patient) the application of free fat grafts. In addition, histological evaluation of the original fat grafts was performed in 4 patients requiring additional surgery.Results:We found no clear association between the use of autologous graft fats and the clinical outcomes in this study.Conclusion:In this preliminary study involving only 36 patients, the prospective randomized use of free autologous fat grafts did not appear to influence outcomes following microdiscectomy.

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“…A number of agents have been used to prevent PF, including pharmaceutical gels, gelfoam, or free fat grafts [10]. Although they are used clinically as the most popular interpositional materials especially after laminectomy [10–12], their efficacy is not as impressive as their popularity [13, 14]. …”

Section: Introductionmentioning

confidence: 99%

Effect of Honey on Peridural Fibrosis Formation after Laminectomy in Rats: A Novel Experimental Study

Farrokhi

Vasei

Fareghbal

et al. 2011

Evidence-Based Complementary and Alternative Medicine

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Despite progress in surgical techniques, some patients still face postoperative recurrence of pain. Recently, more attention has been focused on peridural fibrosis (PF), which may be responsible for recurrent pain after laminectomy or discectomy. Honey has been shown to exert anti-inflammatory effects on exposed tissues besides its well-known antibacterial properties. The aim of this study were to investigate the effects of honey on the prevention of postlaminectomy fibrosis formation in a rat model. A controlled blinded study was performed in 45 male adult white Sprague-Dawley rats that underwent laminectomy at the L5-L6 levels. They were divided into 3 groups (A, B, and C) of 15 rats each. Group A (sham) underwent laminectomy and group B was treated with normal saline at the laminectomy site. Rats in group C received 0.1 mL honey at the laminectomy site. All rats were killed 4 weeks after laminectomy. PF was found in 5 rats (33%) of control groups A and B, and in 2 rats (10%) in honey-treated laminectomy group C. The difference was not statistically significant. Wound healing was not affected, and there was no cerebrospinal fluid leakage. Although honey appears to be safe, it cannot cause a significant reduction of PF formation after lumbar laminectomy in rats.

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Failure of Autologous Fat Grafts to Prevent Postoperative Epidural Fibrosis in Surgery of the Lumbar Spine

Cited by 48 publications

References 0 publications

A modern biomaterial for adhesion prevention

A modern biomaterial for adhesion prevention

Epidural scarring after lumbar disc surgery: Equivalent scarring with/without free autologous fat grafts

Effect of Honey on Peridural Fibrosis Formation after Laminectomy in Rats: A Novel Experimental Study

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