Viscous Carboxymethylcellulose in the Prevention of Epidural Scar Formation

Kitano, Takaaki; Zerwekh, Joseph E.; Edwards, M. Lowell; Usui, Yosuke; Allen, Michael D.

doi:10.1097/00007632-199107000-00023

Cited by 51 publications

(27 citation statements)

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“…More recently, carboxymethylcellulose (CMC) and polyethylene oxide (PEO), which have been shown to reduce adhesions and to interact with the proteins causing fibrosis, respectively, have given surgeons hope that postlaminectomy outcomes can be improved (6,8,12). Clinical studies seem to encourage this hope (1,10).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, carboxymethylcellulose (CMC) and polyethylene oxide (PEO) have been shown to reduce adhesions and to interact with the proteins that cause fibrosis (6,8,12). In 2002, a synthetic combination of CMC/PEO was stabilized with calcium chloride and distributed under the trade names Oxiplex/SP adhesion barrier gel (DePuy International Ltd., Leeds, United Kingdom) and MediShield adhesion barrier gel (Medtronic International Trading SARL, Tolochenaz, Switzerland) in Europe (1).…”

Section: Sucu Hk Et Al: Prevention Of Anterior Scar Formationmentioning

confidence: 99%

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Prevention of anterior scar formation following discectomy with a medishield adhesion barrier: randomized experimental trial

Sucu¹,

Sevin²,

Rezanko³

et al. 2012

Turkish Neurosurgery

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AIm: To investigate whether carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel has a protective effect against epidural scar formation anterior to the dura following discectomy. mAterIAl and methOds: A barrier gel comprised of CMC and PEO (MediShield) was studied as a material to reduce anterior epidural scar formation in a rabbit laminotomy and discectomy model. After laminotomy and disc puncture, the surgical side was either treated with MediShield or used as a surgical control, as determined by random allocation. Two months after surgery, the animals were euthanized, and their lumbar spines were removed in an en bloc excision for pathological evaluation. Scar formation was evaluated as present or absent. results:The MediShield group contained 12 rabbits, and the control group contained 7 rabbits. Epidural fibrosis was observed in two out of twelve specimens (17%) in the MediShield group and in three of seven (43%) cases in the control group (P=0.305, Fisher's Exact Test).COnClusIOn: Though it was not statistically significant, we observed a difference between the MediShield and control group that favored the MediShield group. The application of the CMC/PEO gel might protect against epidural fibrosis after lumbar discectomy, but its efficacy needs to be investigated in larger experimental trials.KeywOrds: Adhesions, Discectomy, Epidural, Fibrosis, Laminotomy ÖZ AmAÇ: Karboksimetilsellüloz/polietilenoksid (CMC/PEO) jelinin diskektomiyi takiben duranın anteriorundaki epidural skar oluşumuna karşı koruyucu etkisinin olup olmadığının araştırılması. yÖntem ve GereÇler: CMC ve PEO'dan oluşan bariyer jel (MediShield), tavşanlarda laminotomi ve diskektomi modelinde, anterior epidural skar oluşumunu azaltmak için bir alet olarak kullanıldı. Laminotomi ve diskin delinmesinden sonra cerrahi taraf, random bölüştürmelerine bağlı olarak, ya cerrahi kontrol grubu olarak kullanıldı ya da MediShield ile tedavi edildi. Cerrahiden iki ay sonra hayvanlar ötanize edildi ve lomber omurgaları patolojik değerlendirmeleri için en blok eksizyon halinde çıkartıldı. Skar formasyonu var veya yok olarak değerlendirildi.BulGulAr: Kontrol grubunda 7 tavşan vardı ve MediShield grubunu 12 tavşan oluşturdu. Epidural fibrozis kontrol grubundaki yedi olgunun üçünde (%43) mevcut iken MediShield grubundaki on iki örneğin ikisinde (%17) bulundu (P=0,305, Fisher's Exact Test).sOnuÇ: İstatistiksel olarak anlamlı olmamasına rağmen, MediShield ile kontrol grubu arasında MediShield grubu lehine bir fark bulduk. CMC/ PEO jeli uygulamasının lomber diskektomi sonrası epidural fibrozis gelişiminin önlenmesinde pozitif bir etkisi olabilir, fakat bunun daha büyük deneysel çalışmalarla araştırılması gerekir.

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Section: Discussionmentioning

confidence: 99%

Section: Sucu Hk Et Al: Prevention Of Anterior Scar Formationmentioning

confidence: 99%

Prevention of anterior scar formation following discectomy with a medishield adhesion barrier: randomized experimental trial

Sucu¹,

Sevin²,

Rezanko³

et al. 2012

Turkish Neurosurgery

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“…One of the most challenging problems during revision lumbar spine surgery is the presence of epidural fibrosis that occurs as regeneration process after a previous surgery [14,26].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a mucolythic agent as a local adjuvant in revision lumbar spine surgery

Denaro¹,

Martino²,

Longo³

et al. 2008

Eur Spine J

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“…Oxiplex gel is formed by polyethilenoxide and carboxymethil cellulose. Both polyethilenoxide and carboxymethil cellulose are known to reduce adhesions and fibrotic scarring that form after surgery 20,31 . Calcium chloride inducing ionic cross-links is added to the formulation to create stronger interaction between the components.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Oxiplex and Gore-Tex effectivity in an experimental peridural fibrosis model

et al. 2009

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SummaryObjective. The authors conducted a study to compare the effectiveness of Oxiplex and Gore-tex in preventing postlaminectomy peridural fibrosis in rats. Peridural fibrosis is a common cause of pain in patients undergoing spinal surgery. To prevent scar formation numerous materials and methods have been employed such as non steroidal anti-inflammatory drugs (NSAIDs), Gelfoam, Oxiplex, Gore-tex, carboxymethil cellulose, Adcon-L, autogenous adipose grefting, mitomisin, and radiotherapy have been investigating for a long time, but only moderate success has been obtained.Methods. Laminectomies were performed at the fourth lumbar vertebra (L-4) in 30 rats. Oxiplex or Gore-Tex was applied over the dura mater with the aim to perform a blinded evaluation of their effects. In the control group, only a L-4 laminectomy was performed. Animals were sacrificed 28 days after the surgical procedure. The extent of peridural fibrosis was evaluated on spine specimens by histological analysis.Results. Both groups of animals treated with either Oxiplex or Gore-Tex showed a significant reduction in the degree of peridural fibrosis as compared to the control group. However no significant difference in the prevention of peridural fibrosis was observed between the Oxiplex and Gore-Tex groups.Conclusions. This experimental model has shown that Oxiplex and Gore-Tex are effective methods to prevent peridural fibrosis and dural adhesions at the postlaminectomy areas.KEY WORDS: Peridural fibrosis. Oxiplex. Gore-Tex. Failed back syndrome.Comparación entre la eficacia del Oxiplex y del GoreTex en un modelo experimental de fibrosis peridural ResumenObjetivo. Los autores realizaron un estudio para comparar la eficacia de Oxiplex y Gore-tex en la prevención de fibrosis peridural tras laminectomías en ratas. La fibrosis peridural es una causa común de dolor en pacientes sometidos a cirugía de la columna vertebral. Para evitar la formación de cicatriz, se han empleado numerosos materiales y métodos como los antiinflamatorios no esteroideos (AINE), Gelfoam, Oxiplex, Gore-tex, carboxymethil celulosa, Adcon-L, injertos de grasa antóloga, mitomicina o la radioterapia, pero sólo se ha obtenido resultados exitosos en pocas ocasiones.Métodos. Se realizaron laminectomías en la cuarta vértebra lumbar (L-4) en 30 ratas. Se aplicaron Oxiplex o Gore-Tex sobre la duramadre con el objetivo de realizar una evaluación ciega de sus efectos. En el grupo control, sólo se realizó la laminectomía L4. Los animales fueron sacrificados 28 días después de la intervención quirúrgica. El grado de fibrosis peridural se evaluó sobre la columna vertebral de especímenes por análisis histológico.Resultados. Ambos grupos de animales tratados con Oxiplex o Gore-Tex mostraron una reducción significativa en el grado de fibrosis peridural en comparación con el grupo control. Sin embargo, ninguna diferencia significativa en la prevención de la fibrosis peridural se observó entre los grupos de Oxiplex y Gore-Tex.Conclusiones. Este modelo experimental ha demostrado que Oxiplex y Gor...

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Viscous Carboxymethylcellulose in the Prevention of Epidural Scar Formation

Cited by 51 publications

References 0 publications

Prevention of anterior scar formation following discectomy with a medishield adhesion barrier: randomized experimental trial

Prevention of anterior scar formation following discectomy with a medishield adhesion barrier: randomized experimental trial

Effectiveness of a mucolythic agent as a local adjuvant in revision lumbar spine surgery

Comparison of Oxiplex and Gore-Tex effectivity in an experimental peridural fibrosis model

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