The effect of urokinase in preventing the formation of epidural fibrosis and/or leptomeningeal arachnoiditis

Ceviz, Adnan; Arslan, Adem; Ak, Huseyin; Inaloz, Serhat

doi:10.1016/s0090-3019(96)00038-9

Cited by 28 publications

(22 citation statements)

References 11 publications

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“…3,5,6,10 Epidural fibrosis still constitutes an important cause of recurrent symptoms after spinal surgery. [2][3][4][5]10 The Presence of a ruptured disc and operation for its removal are the contributing factors in initiating arachnoiditis. The incidence of arachnoiditis was reported between 10 and 40% after disc surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of arachnoiditis was reported between 10 and 40% after disc surgery. 3,5 Fibroblasts, originating from the overlying muscles and following extension of postoperative haematoma in to the vertebral canal, cause epidural fibrosis. [9][10][11] The migration of fibroblasts from the raw surface of the erector spinae musculature was stated as the source of postoperative scar tissue.…”

Section: Discussionmentioning

confidence: 99%

“…5,12 Prevention of postlaminectomy scarring has been attempted using different mechanical barriers, chemical regulation of scar formation and prevention of local Figure 1 Laminectomy site with thick, dense collageneous scar extending into the bone defect (thick arrow) and diffuse attachments to the dura (thin arrow) (H&E Â 40) Figure 2 Photomicrograph showing section of laminectomy site with moderate fibrous tissue presence in control rat (H&E Â 40) rt-PA in experimental epidural fibrosis S Kemaloǧlu et al haematomas. [1][2][3][4] Inflammation was reported to play a role in the occurrence of scar tissue. 10 Although the occlusion of the lamineclomy defect with fat transplants preventing epidural scar formation has been reported, laminectomy defects filled with haematoma resulted in considerable scarring.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] It is postulated that adhesive arachnoiditis may occur with any chemical or physical injury to the leptomeninges. 1,2 It is known that local haematoma has the potential to markedly alter the results [3][4][5][6] and increased epidural adhesion may develop because of local haematoma. 1 Platelet-derived growth factor is a mitogene from aggregating platelets responsible for the migration and proliferation of the myofibroblasts.…”

Section: Introductionmentioning

confidence: 99%

“…Either by a local mass effect of haematoma, or by migration and proliferation of the myofibroblasts generated by platelet-derived growth factor. [1][2][3] Prevention of postlaminectomy scarring has been attempted using different mechanical barriers, chemical regulation of scar formation and prevention of local haematomas. [1][2][3][4] This study was designed to assess the effect of topical recombinant tissue plasminogen activator (rt-PA) on epidural scar formation in rats after laminectomy.…”

Section: Introductionmentioning

confidence: 99%

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Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats

gcaron

Özkan

et al. 2003

Spinal Cord

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Study design: A randomized-controlled experimental study was conducted to investigate the effectiveness of recombinant tissue plasminogen activator (rt-PA) on postlaminectomy epidural fibrosis in rats. Setting: Diyarbakir, Turkey. Methods: In a rat model, allowing objective histopathological quantification, the postoperative epidural scar formation was investigated and the potential of local rt-PA in preventing the production of epidural fibrosis was assessed. Rats were randomly allocated to local rt-PA (12 rats) or control (12 rats). Results: Findings suggest a beneficial effect of rt-PA in decreasing the epidural fibrosis following laminectomy when compared with control groups for all investigated parameters such as intermuscular scar (P ¼ 0.04), middle scar (P ¼ 0.001), deep scar (P ¼ 0.001) and dural adhesion (P ¼ 0.01) except new bone formation. The presence of arachnoiditis was less in treatment group (P ¼ 0.01). Conclusion: In rats, the topical thrombolysis with rt-PA is safe and efficacious in preventing postlaminectomy epidural fibrosis. This Thrombolytic therapy with rt-PA after spine surgery may come to play an important role in the prevention of epidural fibrosis and arachnoiditis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats

gcaron

Özkan

et al. 2003

Spinal Cord

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Preventing peridural fibrosis with nonsteroidal anti-inflammatory drugs

Sandoval

Hernández-Vaquero

2008

Eur Spine J

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Peridural fibrosis is one of the more frequent complications of lumbar surgery. Nonsteroidal antiinflammatory drugs inhibit the inflammatory and fibroblastic response. We performed lumbar laminectomies in 24 rabbits, divided into two groups. The experimental group received 5 mg/kg/day of aceclofenac for 7 days and the control group received 1 cm 3 of physiological saline. The samples were stained using immunohistochemical methods. The cellular populations in the inflammatory reaction and the thickness of the fibrous membrane were quantified. The mean of the fibrous area was always less in the rabbits of the experimental group compared to controls (47% less at 2 weeks and 41% less at 4 weeks). We observed an 8% decrease in the number of fibroblasts with antivimentin monoclonal antibodies in the experimental group. In this model, aceclofenac inhibits the presence of inflammatory cells in the fibrous scar in the early stages and reduces the extension of adhesions without adverse reactions.

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The density of nociceptive SP- and CGRP-immunopositive nerve fibers in the dura mater lumbalis of rats is enhanced after laminectomy, even after application of autologous fat grafts

Saxler¹,

Brankamp²,

Knoch³

et al. 2008

Eur Spine J

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A considerable number of patients complain about pain after lumbar surgery. The spinal dura mater has been debated as a possible source of this pain. However, there is no information if laminectomy influences the nociceptive sensory innervation of the dura. Therefore, we quantitatively evaluated the density of SP-and CGRPimmunopositive nerve fibers in the dura mater lumbalis in an animal model of laminectomy. Twelve adult Lewis rats underwent laminectomy, in six of them the exposed dura was covered by an autologous fat graft. Further six animals without surgical treatment served as controls. Six weeks after surgery, the animals were perfused and the lumbar dura was processed immunohistochemically for the detection of CGRP-and SP-containing nerve fibers. In controls, the peptidergic nerve fibers were found predominantly in the ventral but rarely in the dorsal dura mater lumbalis. After laminectomy, the density of SP-and CGRP-immunopositive neurons significantly increased in ventral as well as in dorsal parts of the dura. Axonal spines could be observed in some cases at the site of laminectomy. The application of autologous fat grafts failed to inhibit the significant increase in the density of peptidergic afferents. Thus, we have provided the first evidence that laminectomies induce an increase in the density of putative nociceptive SP-and CGRP-immunopositive neurons in the lumbar dura mater ascribable to an axonal sprouting of fine nerve fibers. This effect was not prevented by using autologous fat grafts. It is conceivable that the neuronal outgrowth of nociceptive afferents is a cause of low back pain observed after lumbar surgery.

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The effect of urokinase in preventing the formation of epidural fibrosis and/or leptomeningeal arachnoiditis

Cited by 28 publications

References 11 publications

Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats

Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats

Preventing peridural fibrosis with nonsteroidal anti-inflammatory drugs

The density of nociceptive SP- and CGRP-immunopositive nerve fibers in the dura mater lumbalis of rats is enhanced after laminectomy, even after application of autologous fat grafts

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