Histopathologic Analysis of Tamoxifen on Epidural Fibrosis

Ozturk, Yasar; Bozkurt, İsmail; Yaman, Mesut Emre; Güvenç, Yahya; Tolunay, Tolga; Bayram, Pınar; Hayirli, Nazli; Billur, Deniz; Erbay, Fatma Kübra; Şentürk, Salim; Bozkurt, Gökhan

doi:10.1016/j.wneu.2018.01.004

Cited by 20 publications

(15 citation statements)

References 31 publications

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“…Hansen and co-authors have demonstrated that the administration of oral contraceptives (OC) to young women was associated with lower tendon collagen synthesis, probably because the use of OC is associated with lower insulin-like growth factor-1 (IGF-I), which enhances tendon collagen synthesis [45]. Ozturk et al analysed the effect of Tamoxifen, a synthetic non-steroidal antiestrogen used primarily in the treatment of breast cancer, on fibrotic disease via downregulation of TGF1β, with inhibition of fibroblast proliferation and lower collagen density [46]. Other authors have analysed the dependence of the effects on women’s age: estrogen reduces tendon and ligament stiffness, so young women probably have a greater risk of ACL rupture.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity of the fasciae to sex hormone levels: Modulation of collagen-I, collagen-III and fibrillin production

et al. 2019

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Although it is now recognized that women suffer from myofascial pain to a greater extent than men, and that the muscular fasciae can respond to hormonal stimuli, thanks to the expression of sex hormone receptors, how the fasciae can modify their structure under hormonal stimulation is not clear. In this work, an immunocytochemical analysis of collagen-I, collagen-III and fibrillin were carried out on fibroblasts isolated from human fascia lata after in vitro treatment with various levels of sex hormones β-estradiol and/or relaxin-1, according to the phases of a woman’s period (follicular, periovulatory, luteal, post-menopausal phases and pregnancy). This study demonstrates for the first time that fascial cells can modulate the production of some components of the extracellular matrix according to hormone levels, when treated with β-estradiol: collagen-I falls from 6% of positivity in the follicular phase to 1.9 in the periovulatory phase. However, after the addition of relaxin-1 to the cell culture, the production of extracellular matrix decreased and remained at the same level (1.7% of collagen-I, at both follicular and periovulatory levels of hormones). These results confirm the antifibrotic function of relaxin-1, thanks to its ability to reduce matrix synthesis. They are also a first step in our understanding of how some hormonal dysfunctions in women can cause a dysregulation of extracellular matrix production in fasciae.

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Section: Discussionmentioning

confidence: 99%

Sensitivity of the fasciae to sex hormone levels: Modulation of collagen-I, collagen-III and fibrillin production

et al. 2019

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“…FBSS is characterized by persistent, chronic, and disabling pain following spine surgery [ 9 , 18 ]. Epidural and perineural fibrosis are major contributing factors for lower back and radicular pain, accounting for up to 36% of FBSS [ 9 , 10 , 11 , 19 , 20 ]. The formation of epidural fibrosis is an inevitable complication of laminectomy [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The possible mechanism includes the migration of lymphocytes, fibroblasts, and macrophages from paravertebral tissue into the surgical site. The migrating cells contribute to the progression of peridural fibrosis [ 9 , 19 , 21 ]. Spinal epidural fibrosis and adhesions might cause dural mater compression or peridural tethering.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of fibrosis increases the re-operation time and the risk of dural tears [ 22 ]. Ozturk and colleagues [ 19 ] described an arachnoid membrane becoming thickened and adherent to the dura mater after total lumbar laminectomy in a rat model. In FBSS, the main reason for epidural injection failure is surgery-induced perineural fibrosis that impedes injectate delivery to the target lesion [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome

Lee

Sim

Kim

et al. 2020

JCM

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Persistent or recurrent back and leg pain following spinal surgery, known as failed back surgery syndrome (FBSS), significantly limits daily life activities. A lumbar epidural injection can reduce adhesions, inflammation, and nerve compression, although the epidural space can be distorted due to dura mater and epidural tissues changes after spinal surgery. This study analyzed subdural injection during lumbar epidural injection in FBSS patients. We retrospectively analyzed data from 155 patients who received a lumbar interlaminar epidural injection to manage FBSS. We grouped the patients based on the injected contrast medium appearance in the subdural (group S) or epidural spaces (group E) in fluoroscopic contrast images. Demographic, clinical, surgical and fluoroscopic data were recorded and evaluated, as were the pain scores before and after injection. There were 59 patients (38.1%) in the subdural group. Injection distance from the surgery level differed between the groups. Risk of subdural injection at level 1 distance from the surgery level had an odds ratio of 0.374, and at level ≥2, it was 0.172, when compared to level 0. Subdural incidence differed with the distance from surgical site. Physicians should strive to reduce subdural incidence when the injection is planned at surgery site in FBSS.

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“…It is well accepted that epidural brosis causes pulling, stretching or compression of the associated nerve root or dura mater and can lead to persistent back and leg pain following lumbar laminectomy, known as the post laminectomy syndrome, failed back surgery syndrome (FBSS) or post spinal surgery syndrome [6,7]. Revision surgery in these cases has greater complication rates along with decreased success rate to 30% after the second, 15% after the third, and 5% after the fourth surgery [8]. In addition, such repeated surgeries may lead to dural tears, nerve root injuries and excessive bleeding [9].…”

Section: Introductionmentioning

confidence: 99%

Analysis of pain markers and epidural fibrosis caused by repeated spinal surgery in Sprague–Dawley rats

Quan

Kim

Hwang

et al. 2021

Preprint

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Background: Epidural fibrosis is one of the aetiologies of pain following a spinal revision surgery. It is reported that the specific members of the mitogen – activated protein kinases (MAPK) family might mediate neuropathic pain. However, roles of epidural fibrosis caused by repeated spinal surgeries and pain-related proteins in causing the post spinal surgery syndrome remain unknown. Using a rat spinal surgery epidural fibrosis and adhesion model, in this study, we evaluated and investigated the relationship between pain markers and epidural fibrosis. Methods: Sprague–Dawley rats that underwent the spinal surgery were divided into three groups: group A (single laminectomy), group B (two repeated surgeries) and group C (three repeated surgeries). Dural thickness was measured in each experimental group, and immunohistochemical analysis and western blotting of mitogen-activated protein kinases were performed (ERK, p38 and JNK) using the spine cord. Results: Dural thickness was 6.363 ± 1.911 µm in group A, 13.238 ± 2.123 µm in group B and 19.4 ± 2.115 µm in group C, respectively. In the western blotting, phosphorylated ERK expression gradually increased with the number of repeated surgeries, and expression in groups B (1.77-fold) and C (2.42-fold) increased as compared to expression in group A. Phosphorylated p38 showed an increasing trend with the number of repeated surgeries, and groups B (1.17-fold) and C (1.33-fold) expression increased compared with group A. However, phosphorylated JNK expression did not gradually increase with the number of repeated surgeries, and groups B (1.62-fold) and C (1.43-fold) expression increased compared with group A. Excluding phosphorylated JNK, immunohistochemical analysis revealed that phosphorylated ERK and p38 expression gradually increased with the number of repeated surgeries in the spine dorsal horn, as evidenced by western blotting. Conclusions: Repeated spinal surgeries may increase dural thickness and expression of phosphorylated ERK and p38 in the spinal dorsal horn, and it suggests that the neuropathic pain is likely induced by epidural fibrosis and that the pain increases with the number of repeated surgeries.

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Histopathologic Analysis of Tamoxifen on Epidural Fibrosis

Cited by 20 publications

References 31 publications

Sensitivity of the fasciae to sex hormone levels: Modulation of collagen-I, collagen-III and fibrillin production

Sensitivity of the fasciae to sex hormone levels: Modulation of collagen-I, collagen-III and fibrillin production

Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome

Analysis of pain markers and epidural fibrosis caused by repeated spinal surgery in Sprague–Dawley rats

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