Pathological anatomy

doi: 10.25005/2074-0581-2022-24-2-176-184
MORPHOLOGICAL PATTERNS OF DEVELOPMENT AND PREVENTION OF EXPERIMENTAL EPIDURAL FIBROSIS

I.A. Shurygina1, A.P. Zhivotenko1, O.A. Goldberg1, V.A. Sorokovikov1,2, S.N. Larionov1

1Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russian Federation
2Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education, Irkutsk, Russian Federation

Objective: To identify the morphological patterns of development and prevention of experimental epidural fibrosis based on the shape of the dural sac in the area of laminectomy.

Methods: Male Wistar rats aged 4-5 months underwent laminectomy at the level of L6-S1. The animals were divided into two groups with 7 animals per group. In the main group (Group A) the animals were treated with Antiadhesin® gel applied to the wound to prevent the development of epidural fibrosis, while in the group of comparison (Group B), the gel was not applied. Another 7 healthy animals were used as a control group. The animals were taken out of experiment on the 28th day. Histological slides stained with hematoxylin-eosin were used to measure the width and length of the dural sac, its area, perimeter, and calculate its deformity index.

Results: In group B at the level of laminectomy, the ratio of the width to length of the dural sac was significantly higher than in the control group (p<0.05), mainly due to the enlarged width, while the length did not change significantly. In group A these parameters did not differ from the control group, which indicated that application of Antiadhesin® prevented formation of a connective tissue scar which could compress the dural sac and cause its deformation. In group A in the area of surgical intervention, granulomas with Pirogov-Langhans cells were detected, both in the soft tissues and in the lumen of the spinal canal. These findings in perioperative tissues might be related to biocompatibility and indicate their reaction to a gel as a foreign body.

Conclusion: In clinical practice optimal materials for the prevention of epidural fibrosis are missing. There is an obvious need for further research in order to obtain implants capable of inhibiting and reducing the formation of epidural fibrosis.

Keywords: Dura mater, epidural fibrosis, prevention, experiment, laminectomy, Antiadhesin®.

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References
  1. Karukonda TR, Mancini N, Katz A, Cote MP, Moss IL. Lumbar laminectomy in the outpatient setting is associated with lower 30-day complication rates. Global Spine J. 2020;10(4):384-92. Available from: https://doi. org/10.1177/2192568219850095
  2. Grin АА, Nikitin АS, Yusupov SR. Khirurgicheskaya taktika lecheniya stenoza pozvonochnogo kanala na poyasnichnom urovne u lits pozhilogo i starcheskogo vozrasta [Surgical treatment of spinal canal stenosis at the lumbar level in the elderly and senile patients]. Neyrokhirurgiya. 2020;22(1):93-102. Available from: https://doi.org/10.17650/1683-3295-2020-22-1-93-102
  3. Sobti S, Grover A, John BPS, Grewal SS, George UB. Prospective randomized comparative study to evaluate epidural fibrosis and surgical outcome in patients undergoing lumbar laminectomy with epidural autologous free fat graft or Gelfoam: A preliminary study. Int J Appl Basic Med Res. 2018;8(2):71-5. Available from: https://doi.org/10.4103/ijabmr.IJABMR_349_17
  4. Zhivotenko AP, Shurygina IA, Goldberg OA, Koshkaryova ZV. Mitogen-aktiviruemye proteinkinazy i ikh znachimost' v reparativnom protsesse pri laminektomii: fundamental'nye aspekty [Mitogen-activated protein kinases and their significance in the reparative process in laminectomy: Fundamental aspects]. Sovremennye problemy nauki i obrazovaniya. 2020;(4):151. Available from: https://doi.org/10.17513/spno.29919
  5. Mohi Eldin MM, Abdel Razek NM. Epidural fibrosis after lumbar disc surgery: Prevention and outcome evaluation. Asian Spine J. 2015;9 (3):370-85. Available from: https://doi.org/10.4184/asj.2015.9.3.370
  6. Wang K, Li XL, Liu J, Sun X, Yang H, Gao X. Using cross-linked hyaluronic acid gel to prevent postoperative lumbar epidural space adhesion: In vitro and in vivo studies. Eur Spine J. 2020;29(1):129-40. Available from: https://doi. org/10.1007/s00586-019-06193-w
  7. Bolat E, Kocamaz E, Kulahcilar Z, Yilmaz A, Topcu A, Ozdemir M, Coskun ME. Investigation of efficacy of Mitomycin-C, sodium hyaluronate and human amniotic fluid in preventing epidural fibrosis and adhesion using a rat laminectomy model. Asian Spine J. 2013;7(4):253-9. Available from: https://doi. org/10.4184/asj.2013.7.4.253
  8. Bosscher HA, Heavner JE. Incidence and severity of epidural fibrosis after back surgery: An endoscopic study. Pain Pract. 2010;10(1):18-24. Available from: https://doi.org/10.1111/j.1533-2500.2009.00311.xBosscher HA, Heavner JE. Incidence and severity of epidural fibrosis after back surgery: An endoscopic study. Pain Pract. 2010;10(1):18-24. Available from: https://doi.org/10.1111/j.1533-2500.2009.00311.x
  9. Ji GY, Oh CH, Moon BG, Yi S, Han IB, Heo DH, et al. Efficacy and safety of sodium hyaluronate with 1,4-butanediol diglycidyl ether compared to sodium carboxymethylcellulose in preventing adhesion formation after lumbar discectomy. Korean J Spine. 2015;12(2):41-7. Available from: https://doi.org/10.14245/ kjs.2015.12.2.41
  10. Ross JS, Robertson JT, Frederickson RC, Petrie JL, Obuchowski N, Modic MT, et al. Association between peridural scar and recurrent radicular pain after lumbar discectomy: Magnetic resonance evaluation. ADCON-L European Study Group. Neurosurgery. 1996;38(4):855-63.
  11. Quan M, Hwang WH, Kim JH, Kim YY. Analysis of pain markers and epidural fibrosis caused by repeated spinal surgery in Sprague-Dawley rats. BMC Musculoskelet Disord. 2021;22(1):16. Available from: https://doi.org/10.1186/ s12891-020-03920-z
  12. Daniell JR, Osti OL. Failed back surgery syndrome: A review article. Asian Spine Journal. 2018;12(2):372-9. Available from: https://doi.org/10.4184/ asj.2018.12.2.372
  13. Eisenmenger L, Clark AJ, Shah VN. Postoperative spine: What the surgeon wants to know. Radiologic Clinics of North America. 2019;57(2):415-38. Available from: https://doi.org/10.1016/j.rcl.2018.10.003
  14. Zhivotenko AP, Koshkaryova ZV, Sorokovikov VA. Profilaktika posleoperatsionnogo rubtsovo-spaechnogo epidurita: sovremennoe sostoyanie voprosa [Prevention of postoperative epidural fibrosis: Current status of the issue]. Khirurgiya pozvonochnika. 2019;16(3):74-81. Available from: https://doi. org/10.14531/ss2019.3.74-81
  15. Takenaka S, Makino T, Sakai Y, Kashii M, Iwasaki M, Yoshikawa H, et al. Prognostic impact of intra- and postoperative management of dural tear on postoperative complications in primary degenerative lumbar diseases. The Bone & Joint Journal. 2019;101-B(9):1115-21. Available from: https://doi. org/10.1302/0301-620X.101B9.BJJ-2019-0381.R1
  16. Bahrami R, Akbari E, Rasras S, Jazayeri N, Khodayar MJ, Foruozandeh H, et al. Effect of local N-acetyl-cysteine in the prevention of epidural fibrosis in rat laminectomy model. Asian Journal of Neurosurgery. 2018;13(3):664-8. Available from: https://doi.org/10.4103/ajns.AJNS_294_16
  17. Zhivotenko AP, Sorokovikov VA, Koshkaryova ZV. Klinicheskiy sluchay formirovaniya adgezivnogo arakhnoidita na fone epidural'nogo fibroza kak prichina povtornykh khirurgicheskikh vmeshatel'stv [Formation of adhesive arachnoiditis with epidural fibrosis as a cause of repeated surgical interventions (clinical case).]. Acta Biomedica Scientifica. 2019;5(3):54-61. Available from: https:// doi.org/ 10.29413/ABS.2020-5.3.8
  18. Shvets VV, Kolesov SV, Karpov IN, Panteleev AA, Skorina IV, Gorbatyuk DS. Protivospaechnyy gel' «Antiadgezin» pri degenerativnykh zabolevaniyakh poyasnichnogo otdela pozvonochnika [Antiadhesion barrier gel for degenerative diseases of the lumbar spine]. Khirurgiya pozvonochnika. 2018;15(2):39-50. Available from: https://doi.org/10.14531/ss2018.2.39-50
  19. Wang H, Sun W, Fu D, Shen Y, Chen YY, Wang LL. Update on biomaterials for prevention of epidural adhesion after lumbar laminectomy. Journal of Orthopaedic Translation. (2018);13:41-9. Available from: https://doi.org/10.1016/j. jot.2018.02.001
  20. Goldberg OA, Zhivotenko AP, Samoylova LG, Sorokovikov VA, Shurygina IA. Izmenenie formy dural'nogo meshka na modeli laminektomii na raznykh srokakh reparatsionnogo protsessa v eksperimente [Change of the shape of the dural sac in the laminectomy model at different stages of the reparation in the experiment]. Acta Biomedica Scientifica. 2020;5(6):259-64. Available from: https://doi.org/10.29413/ABS.2020-5.6.34
  21. Zhivotenko AP, Goldberg OA, Sorokovikov VA, Koshkaryova ZV, Shurygina IA. Formirovanie epidural'nogo fibroza pri povrezhdenii tvyordoy mozgovoy obolochki pri lyaminektomii v eksperimente [Formation of epidural fibrosis in case of dura mater damage during laminectomy in the experiment]. Sovremennye problemy nauki i obrazovaniya. 2019;4:60. Available from: https://doi.org/ 10.17513/spno.29118
  22. Shurygina IA, Shurygin MG. Sposob prigotovleniya preparata kostnoy tkani i nabor dlya ego osushchestvleniya [A method for preparing a bone tissue preparation and a kit for its implementation]. Patent Rossiyskoy Federatsii № 2500104. 10.12.2013.
  23. Percie du Sert N, Ahluwalia A, Alam S, Avey MT, Baker M, Browne WJ, et al. Reporting animal research: Explanation and elaboration for the ARRIVE guidelines 2.0. PLoS Biol. 2020;18(7):1-65 Available from: https://doi.org/10.1371/ journal.pbio.3000411

Author information:


Shurygina Irina Aleksandrovna
Doctor of Medical Sciences, Full Professor, Deputy Director for Science, Irkutsk Scientific Centre of Surgery and Traumatology
ORCID ID: 0000-0003-3980-050X
SPIN: 6745-5426
Author ID: 161435
E-mail: irinashurygina@gmail.com

Zhivotenko Aleksandr Petrovich
Researcher, Research Clinical Department of Neurosurgery, Irkutsk Scientific Centre of Surgery and Traumatology
ORCID ID: 0000-0002-4032-8575
SPIN: 8016-5626
Author ID: 959049
E-mail: sivotenko1976@mail.ru

Goldberg Oleg Aronovich
Candidate of Medical Sciences, Leading Researcher, Irkutsk Scientific Centre of Surgery and Traumatology
ORCID ID: 0000-0003-1040-284X
SPIN: 1591-9935
Author ID: 559901
E-mail: goldberg.ol@yandex.ru

Sorokovikov Vladimir Alekseevich
Doctor of Medical Sciences, Full Professor, Director, Irkutsk Scientific Centre of Surgery and Traumatology; Head of the Department of Traumatology, Orthopedy and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
ORCID ID: 0000-0002-9008-6383
SPIN: 8379-4458
Author ID: 441270
E-mail: vasorokovikov@mail.ru

Larionov Sergey Nikolaevich
Doctor of Medical Sciences, Leading Researcher, Head of the Scientific and Clinical Department of Neurosurgery, Irkutsk Scientific Centre of Surgery and Traumatology
ORCID ID: 0000-0001-9189-3323
SPIN: 6720-4117
Author ID: 639993
E-mail: snlar@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:


Zhivotenko Aleksandr Petrovich
Researcher, Research Clinical Department of Neurosurgery, Irkutsk Scientific Centre of Surgery and Traumatology

664003, Russian Federation, Irkutsk, Bortsov Revolyutsii str., 1

Tel.: +7 (914) 8752067

E-mail: sivotenko1976@mail.ru

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