Two-year results after lumbar microdiscectomy with and without prophylaxis of a peridural fibrosis using Adcon-L

Ganzer, D.; Giese, Katrin; Völker, Ludwig; Pietzner, Uwe; Follak, N.; Merk, H.

doi:10.1007/s00402-002-0455-y

Cited by 30 publications

(13 citation statements)

References 29 publications

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“…Unfortunately, systemic adverse effects of this formulation have been reported, in addition to fistula formation. As a result, the inhibition of local fibroblasts during postoperative wound healing is no longer considered a feasible preventive method, and clinical observations did not demonstrate any positive effect of this approach in the postoperative period [15][16][17][18]. Other methods used to create the anti-adhesion barrier include the application of isolation gel (carboxymethylcellulose and poly(ethylene oxide) (PEO)-based Oxiplex gel, US).…”

Section: Discussionmentioning

confidence: 99%

“…The material itself as well as its degradation products must be recognized by the body as natural metabolites. Both the inherent characteristics and manufacturing process of the isolation material must allow for the determination of the biodegradation period following in situ insertion into the tissues.Excessive cicatrisation observed after spinal canal procedures is a clinical problem and is assumed to contribute to poor neurosurgical outcomes in approximately 15-20% of patients [15,26,30,41,42]. The assessment of poor neurosurgical outcomes attributed to excessive cicatrisation and contributing to "failed back syndrome" should involve exclusion of other causes, such as inadequate surgical methods (with its overarching assumption that disc herniation can be treated effectively without the use of optical techniques), recurrent disc herniation, foraminal stenosis, postoperative spinal instability and neuropathic pain as a result of nerve root damage.…”

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confidence: 99%

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Original article Nanofiber nets in prevention of cicatrisation in spinal procedures. Experimental study

Andrychowski¹,

Frontczak-Baniewicz²,

Sulejczak³

et al. 2013

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Folia Neuropathologica 2013; 51/2 147 Nanofiber nets in prevention of cicatrisation in spinal procedures. Experimental study J Ja ar ro os sł ła aw w A An nd dr ry yc ch ho ow ws sk ki i 1 1, ,2 2 , , M Ma ał łg go or rz za at ta a F Fr ro on nt tc cz za ak k--B Ba an ni ie ew wi ic cz z A b s t r a c t Excessive cicatrisation or epidural fibrosis in the operative field is an inappropriate event occasionally occurring after neurosurgical procedures (i.e., spine procedures and craniotomies). This excessive process may disturb the postoperative course and render reoperations more difficult and risky. The literature describes this phenomenon as accompanying up to 20% of neurosurgical procedures. The scar tissue that forms postoperatively adheres to the dura mater, penetrates into the spinal canal and can cause narrowing symptoms, neurological deficits and pain. The incidence and spread of this excessive scar or epidural fibrosis can be prevented through the modification of the surgical technique by incorporating endoscopic or microscopic access to minimize the operative field and the use of isolating substances (autogenous or heterogeneous) administered intraoperatively. The aim of this experimental study was to morphologically assess the cicatrisation process, adhesion and to prevent excessive scar formation with the local use of membranes manufactured by an electrospinning process (nanotechnology). We also investigated whether the biodegradable nanofibrous net triggers or modifies the immunological response or the local inflammatory process. Micro-nanofibrous membranes were produced by the electrospinning process. A biodegradable, medically certified copolymer poly(L-lactide-co-caprolactone) (PLCL) was IntroductionThe first papers on cicatrisation or the process of epidural fibrosis after neurosurgical procedures date back to the 1970s [4,26,27,43]. Developments and progress in the field of spinal surgery have caused the number of patients undergoing these procedures to multiply [4]. Long-term postoperative observations have demonstrated excessive cicatrisation within the spinal canal and its dural and neural components to be one of the factors adversely affecting the postoperative period [10,26,28,30,41,42]. We observed this improper cicatrisation involving the neural elements after the dura and arachnoid matter damage in the different neurosurgical procedures. Epidural fibrosis is considered to be one of the mechanisms that may be responsible for postoperative pain [30,41,42]. Cicatrisation is a part of the natural and normal healing process that makes any surgery possible, but excessive or inappropriate scar formation is an adverse process in the surgical context.In neurosurgery, excessive cicatrisation can lead to neurological symptoms and pain. Its prevention is based on three methods specifically designed to significantly reduce epidural fibrosis, adhesion and/or excessive cicatrisation. The first method is based on minimizing the surgical field exposure using microscopic and endoscopic approaches [16,27...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Original article Nanofiber nets in prevention of cicatrisation in spinal procedures. Experimental study

Andrychowski¹,

Frontczak-Baniewicz²,

Sulejczak³

et al. 2013

View full text Add to dashboard Cite

show abstract

“…A multitude of studies have been performed to evaluate the use of various products as antiadhesion barriers [2], [6], [9], [10], [13], [20], [22], [24], [25], [27], [28], [30], [31], [32], [33], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [52], [53], [54], [55], [56], [57], [59], [60], [61], [62], [64], [65], [67], [68], [69], [70] . Although scar formation is a normal part of the healing process, excessive scarring or scarring in regions where adhesions cause anatomical dysfunction (eg, intestinal adhesions) is detrimental.…”

Section: Discussionmentioning

confidence: 99%

Bioresorbable film for the prevention of adhesion to the anterior spine after anterolateral discectomy

Klopp¹,

Toth²,

Welch³

et al. 2009

The Spine Journal

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“…10,12,14,15,21,29,30 During lumbar decompression surgery, very small dural tears may occur that are not noticed at the time of surgery. 16,19 The true incidence of such tears is unknown, perhaps because epidural inflammation (dependent in part on fibroblast activity) allows for scar formation and the natural healing of small tears.…”

Section: Proposed Mechanism Of Epidural Triamcinolone Acetonide Use Amentioning

confidence: 99%

Safety of epidural triamcinolone acetonide use during lumbar decompression surgery in pediatric patients: an association with delayed pseudomeningocele formation

Sellin

Vedantam

Luerssen

et al. 2016

PED

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OBJECTIVE The complication profile of epidural triamcinolone acetonide use during lumbar decompression surgery is not known. However, isolated reports of increased risk of delayed CSF leakage with the use of triamcinolone acetonide in adult spinal surgery patients have been published. The purpose of this study was to determine the safety of epidural triamcinolone acetonide use in conjunction with lumbar decompression surgery in pediatric patients. METHODS The medical records of all patients who underwent lumbar decompression surgery with or without discectomy between July 1, 2007, and July 31, 2015, were retrospectively reviewed. RESULTS During the study period, 58 patients underwent 59 spine procedures at Texas Children's Hospital. There were 33 female and 25 male patients. The mean age at surgery was 16.5 years (range 12–24 years). Patients were followed for an average of 38.2 months (range 4–97 months). Triamcinolone acetonide was used in 28 (of 35 total) cases of discectomy; there were no cases of delayed symptomatic CSF leaks (0%) in the minimally invasive and open discectomies. On the other hand, triamcinolone acetonide was used in 14 (of 24 total) cases of multilevel laminectomy, among which there were 10 delayed CSF leaks (71.4%) requiring treatment. The use of triamcinolone acetonide in patients who underwent multilevel laminectomy was significantly associated with an increased risk of delayed CSF leaks or pseudomeningoceles (Fisher's exact test, p < 0.001). CONCLUSIONS There was an unacceptable incidence of delayed postoperative CSF leaks when epidural triamcinolone acetonide was used in patients who underwent multilevel laminectomy.

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Two-year results after lumbar microdiscectomy with and without prophylaxis of a peridural fibrosis using Adcon-L

Abstract: A significant effect on the clinical results after Adcon-L application could not be found.

Cited by 30 publications

References 29 publications

Original article Nanofiber nets in prevention of cicatrisation in spinal procedures. Experimental study

Original article Nanofiber nets in prevention of cicatrisation in spinal procedures. Experimental study

Bioresorbable film for the prevention of adhesion to the anterior spine after anterolateral discectomy

Safety of epidural triamcinolone acetonide use during lumbar decompression surgery in pediatric patients: an association with delayed pseudomeningocele formation

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