Postlaminectomy Osteopontin Expression and Associated Neurophysiological Findings in Rat Peridural Scar Model

Brzezicki, Grzegorz; Jankowski, Roman; Blok, Tomasz; Klimczak, Aleksandra; Szymaś, Janusz; Huber, Juliusz; Szukała, Agnieszka; Siemionow, Maria; Nowak, S.

doi:10.1097/brs.0b013e3181d12ef4

Cited by 13 publications

(17 citation statements)

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“…Multiple causes shown for revision surgery in these reports were related to herniated disc, stenosis, disc degeneration, spondylolysis, spondylolisthesis, and scoliosis 29,30. However, multiple other causes not requiring repeat surgery, or managed by interventional techniques that are responsible for continued persistent pain and disability include epidural fibrosis, sacroiliac joint pain, disc herniation, discogenic pain, spinal stenosis, and facet joint pain 11,24-28,31,32. Even though it is widely accepted that epidural fibrosis is a major cause of complications after lumbar spine surgery, the role of peridural scarring in recurrent radicular pain has been weighed and extensively debated 32.…”

Section: Introductionmentioning

confidence: 93%

“…However, multiple other causes not requiring repeat surgery, or managed by interventional techniques that are responsible for continued persistent pain and disability include epidural fibrosis, sacroiliac joint pain, disc herniation, discogenic pain, spinal stenosis, and facet joint pain 11,24-28,31,32. Even though it is widely accepted that epidural fibrosis is a major cause of complications after lumbar spine surgery, the role of peridural scarring in recurrent radicular pain has been weighed and extensively debated 32. Ross et al 25 found that patients with extensive peridural fibrosis were 3.2 times more likely to experience recurrent radicular pain than those with less scarring.…”

Section: Introductionmentioning

confidence: 99%

“…Further, it has been shown that epidural fibrosis in the vertebral canal by invasion may cause mechanical tethering of nerve roots 34,35 and disturbances in blood flow 36 and express pro-inflammatory cytokines, which may irritate exposed dorsal root ganglion (DRG) and trigger painful responses 37. Osteopontin also has been identified as a major player in the formation of epidural fibrosis and a mark-up DRG response to peridural scar formation 32. Consequently, epidural fibrosis may be a causative factor in at least 20% to 36% of all cases for failed back surgery syndrome 24-26.…”

Section: Introductionmentioning

confidence: 99%

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Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Control Trial

Manchikanti¹,

Singh²,

Cash³

et al. 2012

Int. J. Med. Sci.

125

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Study Design: A randomized, active control, double-blind trial. Objective: To evaluate the effectiveness of fluoroscopically directed caudal epidural injections with or without steroids in managing chronic low back and lower extremity pain secondary to post lumbar surgery syndrome. Summary of Background Data: There is a paucity of evidence concerning caudal epidural injections for managing chronic persistent low back pain with or without lower extremity pain caused by post lumbar surgery syndrome.Methods: This active control randomized study included 140 patients with 70 patients in each group. Group I received 0.5% lidocaine, 10 mL; Group II received 9 mL of 0.5% lidocaine mixed with 1 mL of 6 mg of nonparticulate betamethasone. The multiple outcome measures included the numeric rating scale, the Oswestry Disability Index 2.0, employment status, and opioid intake with assessments at 3, 6, 12, 18, and 24 months posttreatment. Primary outcome was defined as at least 50% improvement in pain and Oswestry Disability Index scores. Patients with a positive response to the first 2 procedures with at least 3 weeks of relief were considered to be successful. All others were considered as failures.Results: Overall in Group I, 53% and 47% of the patients and in Group II, 59% and 58% of the patients, showed significant improvement with reduction in pain scores and disability index at 12 months and 24 months. In contrast, in the successful groups, significant pain relief and improvement in function were observed in 70% and 62% of Group I at one and 2 years; in 75% and 69% of Group II at one and 2 years. The results in the successful group showed that at the end of the first year patients experienced approximately 38 weeks of relief and at the end of 2 years Group I had 62 weeks and Group II had 68 weeks of relief. Overall total relief for 2 years was 48 weeks in Group I and 54 weeks in Group II. The average procedures in the successful groups were at 4 in one year and 6 at the end of 2 years.Conclusion: Caudal epidural injections of local anesthetic with or without steroid might be effective in patients with chronic persistent low back and/or lower extremity pain in patients with post lumbar surgery syndrome.

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Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Control Trial

Manchikanti¹,

Singh²,

Cash³

et al. 2012

Int. J. Med. Sci.

125

View full text Add to dashboard Cite

show abstract

“…While the debate continues on epidural fibrosis as being the major cause of pain after lumbar spine surgery with multiple authors describing lack of association,21–23 Ross et al found that patients with extensive epidural fibrosis were 3.2 times more likely to experience recurrent radicular pain than those with less scarring 8. In addition, experimental studies have provided electrophysiological evidence of neurologic disturbances caused by peridural scar formation 24.…”

Section: Introductionmentioning

confidence: 99%

Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial

Manchikanti¹,

Singh²,

Cash³

et al. 2012

JPR

102

172

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BackgroundThe literature is replete with evaluations of failed surgery, illustrating a 9.5%–25% reoperation rate. Speculated causes of post lumbar surgery syndrome include epidural fibrosis, acquired stenosis, recurrent disc herniation, sacroiliac joint pain, and facet joint pain among other causes.MethodsPatients (n = 120) were randomly assigned to two groups with a 2-year follow-up. Group I (control group, n = 60) received caudal epidural injections with catheterization up to S3 with local anesthetic (lidocaine 2%, 5 mL), nonparticulate betamethasone (6 mg, 1 mL), and 6 mL of 0.9% sodium chloride solution. Group II (intervention group, n = 60) received percutaneous adhesiolysis of the targeted area, with targeted delivery of lidocaine 2% (5 mL), 10% hypertonic sodium chloride solution (6 mL), and nonparticulate betamethasone (6 mg). The multiple outcome measures included the Numeric Rating Scale, the Oswestry Disability Index 2.0, employment status, and opioid intake with assessments at 3, 6, 12, 18, and 24 months posttreatment. Primary outcome was defined as 50% improvement in pain and Oswestry Disability Index scores.ResultsSignificant improvement with at least 50% relief with pain and improvement in functional status was illustrated in 82% of patients at the 2-year follow-up in the intervention group compared to 5% in the control group receiving caudal epidural injections. The average number of procedures over a period of 2 years in Group II was 6.4 ± 2.35 with overall total relief of approximately 78 weeks out of 104 weeks.ConclusionThe results of this study show significant improvement in 82% of patients over a period of 2 years with an average of six to seven procedures of 1-day percutaneous adhesiolysis in patients with failed back surgery syndrome.

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“…The samples were harvested and analyzed 2 weeks and 3 weeks after laparotomy. Brzezicki et al, [34] also indicated that a significant difference in the extent of scarring between a laminectomy and sham group could be observed 6 weeks after surgery. Furthermore, Kato et al, [35] demonstrated that it was not possible to quantitatively evaluate the degree of adhesion at 24 weeks after surgery in a rabbit model, because new bone growth was so significant at the laminectomy site in all groups.…”

Section: Discussionmentioning

confidence: 94%

Anti-adhesive effect of hyaluronate in a rabbit laminectomy model

Chen¹,

Lee²,

Tsai³

et al. 2014

Biomed J

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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)

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Postlaminectomy Osteopontin Expression and Associated Neurophysiological Findings in Rat Peridural Scar Model

Cited by 13 publications

References 55 publications

Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Control Trial

Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Control Trial

Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial

Anti-adhesive effect of hyaluronate in a rabbit laminectomy model

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Postlaminectomy Osteopontin Expression and Associated Neurophysiological Findings in Rat Peridural Scar Model

Cited by 13 publications

References 55 publications

Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Con­trol Trial

Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Con­trol Trial

Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial

Anti-adhesive effect of hyaluronate in a rabbit laminectomy model

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Product

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Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Control Trial

Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Control Trial