Bozkurt Huseyin, Bozkurt Emel Cicek, Ozpinar Hulya, Arac Densel, Kaya Ismail, Ozer Hidir, Egilmez Reyhan
Department of Neurosurgery, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
Department of Dermatology, Numune State Hospital, Sivas, Turkey.
World Neurosurg. 2018 Sep;117:e403-e410. doi: 10.1016/j.wneu.2018.06.044. Epub 2018 Jun 15.
Postoperative epidural adhesion is a frequent cause of failed back surgery syndrome, manifesting with back and leg pain or neurologic deficits. Development of preventive measures for epidural adhesion after laminectomy is critical to improve outcomes of lumbar surgery. We hypothesized that positive effects of topical application of Contractubex (CTX) gel and benzothiazole (BT) individually and in combination could aid in preventing epidural fibrosis in a rat laminectomy model.
Rats were randomly assigned to 2 control and 5 experimental groups (n = 8 for each group). The control(-) group received no surgery, whereas the control(+) group underwent laminectomy without any drug administration. In experimental groups, study agents applied to dura mater after laminectomy were 100mgCTX, 2.5%BT, 5%BT; 100mgCTXplus2.5%BT, and 100mgCTXplus5%BT. Laminectomy was performed at the L3 level for all rats. The extent of epidural fibrosis was assessed 4 weeks later macroscopically and histopathologically. Hepatic and renal toxicity of study drugs was assessed histopathologically.
Topical CTX and BT individually and in combination reduced epidural fibrosis after laminectomy in rats. Although a meaningful decrease of epidural fibrosis with individual application of CTX and BT (2.5% or 5%) was obtained (P < 0.05), the effect of their combination was more pronounced without meaningful hepatic and renal toxicity (P < 0.05).
Combined use of topical CTX and BT could be a potential therapy for epidural fibrosis. Further research with this agents for the prevention of epidural fibrosis is warranted.
术后硬膜外粘连是腰椎手术失败综合征的常见原因，表现为腰腿痛或神经功能缺损。制定椎板切除术后硬膜外粘连的预防措施对于改善腰椎手术效果至关重要。我们假设单独及联合局部应用康瑞保（CTX）凝胶和苯并噻唑（BT）对预防大鼠椎板切除术后硬膜外纤维化具有积极作用。
将大鼠随机分为2个对照组和5个实验组（每组n = 8）。对照组（-）不进行手术，而对照组（+）进行椎板切除术但不给予任何药物。在实验组中，椎板切除术后应用于硬脑膜的研究药物分别为100mg CTX、2.5% BT、5% BT；100mg CTX加2.5% BT，以及100mg CTX加5% BT。所有大鼠均在L3水平进行椎板切除术。4周后通过宏观和组织病理学评估硬膜外纤维化程度。通过组织病理学评估研究药物的肝毒性和肾毒性。
局部应用CTX和BT单独及联合使用均可减少大鼠椎板切除术后的硬膜外纤维化。虽然单独应用CTX和BT（2.5%或5%）可使硬膜外纤维化有显著降低（P < 0.05），但其联合应用的效果更明显，且无明显的肝毒性和肾毒性（P < 0.05）。
局部应用CTX和BT联合使用可能是治疗硬膜外纤维化的一种潜在疗法。有必要对这些药物预防硬膜外纤维化进行进一步研究。
