Investigation of Efficacy of Mitomycin-C, Sodium Hyaluronate and Human Amniotic Fluid in Preventing Epidural Fibrosis and Adhesion Using a Rat Laminectomy Model

Abstract

Study DesignA retrospective study.PurposeThe aim of this study was to evalute the effects of mitomycin-C, sodium hyaluronate and human amniotic fluid on preventing spinal epidural fibrosis.Overview of LiteratureThe role of scar tissue in pain formation is not exactly known, but it is reported that scar tissue causes adhesions between anatomic structures. Intensive fibrotic tissue compresses on anatomic structures and increases the sensitivity of the nerve root for recurrent herniation and lateral spinal stenosis via limiting movements of the root. Also, neuronal atrophy and axonal degeneration occur under scar tissue.MethodsThe study design included 4 groups of rats: group 1 was the control group, groups 2, 3, and 4 receieved antifibrotic agents, mitomycin-C (group 2), sodium hyaluronate (group 3), and human amniotic fluid (group 4). Midline incision for all animals were done on L5 for total laminectomy. Four weeks after the surgery, the rats were sacrificed and specimens were stained with hematoxylin-eosin and photos of the slides were taken for quantitive assesment of the scar tissue.ResultsThere was no significant scar tissue in the experimental animals of groups 2, 3, and 4. It was found that there was no significant difference between drug groups, but there was a statistically significant difference between the drug groups and the control group.ConclusionsThis experimental study shows that implantation of mitomycin-C, sodium hyaluronate and human amniotic fluid reduces epidural fibrosis and adhesions after spinal laminectomy in rat models. Further studies in humans are needed to determine the complications of the agents researched.

Placenta and Placental Derivatives in Regenerative Therapies: Experimental Studies, History, and Prospects

“…Amniotic fluid is rarely used in experimental and clinical studies compared to the other placental material due to a smaller number of cells and the active compounds, as well as due to the difficulty of obtaining under sterile conditions. Nevertheless, certain researchers reported the efficiency of the amniotic fluid in bone healing [ 113 ], regeneration of nerve tissue [ 114 ], and prevention of epidural fibrosis [ 115 ]. Recently, an interest in amniotic fluid as a source of stem cells has increased due to a potential in the correction of pathologies of the nervous, musculoskeletal, reproductive, and cardiovascular systems [ 99 , 116 , 117 ].…”

Preventative effect of diclofenac sodium and/or diltiazem in rats with epidural fibrosis

“…Non-steroidal anti-infl ammatory drugs (NSAIDs) (5), calcium channel blockers (6), pegaptanid sodium (7), mitomycin-C (2), hemostatic polysaccharide agents have been administered (8). All-trans retinoic acid (9), human amniotic fl uid-sodium hyaluranate (10), poly (D, L-lactic acid-co-glycolic acid)-b-poly (ethylene glycol)-b-poly (D, L-lactic acid-co-glycolic acid) thermogel (11), etarnacept (12), dekorin (13), CMC/PO (14), licofelone (15), temozolamide (16), polymethylmethacrylate (17) and hyperbaric oxygen (18) are examples of other agents that have been studied in the treatment of spinal EF.…”

Prevention of postoperative epidural fibrosis: current status of the issue

“…Роль эпидурального фиброза в формировании болевого синдрома точно не установлена, но известно, что рубцовая ткань образует спайки между сосудисто-невральными анатомическими структурами позвоночного канала, компримирует их и повышает чувствительность нервного корешка при формировании рецидивирующей грыжи и фораминального стеноза позвоночника за счет ограничения его движений. Кроме того, под рубцовой тканью происходит атрофия нейронов и демиелинизация аксонов [18].…”

“…В литературе имеются сведения об одномоментном использовании физических барьеров в комбинации с различными лекарственными препаратами: стероидными и нестероидными противовоспалительными соединениями [50,51], веществами, ингибирующими специфические цитокины или проницаемость сосудов [5,18,52], веществами, избирательно ингибирующими эндотелиальный фактор роста сосудов (VEGF), например, Ранибизумаб подавляет процесс васкуляризации в послеоперационном поврежденном участке, тем самым снижая развитие и формирование рубцовой ткани. Данное положение доказано экспериментальными исследованиями [53] на крысах породы Wistar и подтверждено гистоморфологическими исследованиями.…”