Department of Neurosurgery, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
Department of Neurosurgery, Health Sciences University Bağcılar Training Research Hospital, İstanbul, Turkey
Turk J Med Sci. 2021 Aug 30;51(4):2206-2212. doi: 10.3906/sag-2002-162.
BACKGROUND/AIM: Epidural fibrosis (EF) is a common cause of failed back surgery syndrome seen after spinal surgeries. The most frequent reason for the formation of EF is accumulated blood and its products in the operation zone. On the development of EF, the effect of bipolar coagulation and fibrillar oxidized cellulose, which are used frequently to control bleeding, was investigated.
In the study, 45 male Sprague Dawley rats were divided into three groups (control, fibrillar, and bipolar). Lumbar laminectomy was applied to all rats under sterile conditions. In the control group, the epidural area was washed with saline solution. Bleeding was controlled with fibrillar oxidized cellulose in the fibrillar group, with bipolar coagulation in the bipolar group. The area to which laminectomy had been applied was removed as a block 6 weeks later and evaluated histopathologically and genetically in terms of EF development. Fibrosis degree was determined histopathologically by counting fibroblasts using the modified Lubina and EF He grading systems. Interleukin-6 (IL-6), transforming growth factor beta-1 (TGFβ-1), and mRNA levels were measured by the droplet digital polymerase chain reaction method.
The number of epidural fibroblasts, percentage of modified Lubina, amount of IL-6, and He grading rates were significantly lower in the fibrillar group than in the bipolar and control groups (p ˂ 0.05). On the other hand, there was no significant difference among the control, fibrillar, and bipolar groups in terms of TGFβ-1 values (p= 0.525).
The use of fibrillar oxidized cellulose was more effective for hemostasis than bipolar coagulation in reducing the development of EF.
背景/目的：硬膜外纤维化（EF）是脊柱手术后出现的失败性腰背痛综合征的常见原因。EF 形成的最常见原因是手术区域内积聚的血液及其产物。本研究旨在研究在 EF 的发展过程中，经常用于控制出血的双极电凝和纤维状氧化纤维素的作用。
本研究中，将 45 只雄性 Sprague Dawley 大鼠分为三组（对照组、纤维状组和双极组）。所有大鼠均在无菌条件下行腰椎板切除术。在对照组中，硬膜外区域用生理盐水冲洗。在纤维状组中，用纤维状氧化纤维素控制出血，在双极组中用双极电凝控制出血。6 周后，整块切除行椎板切除术的区域，并从组织病理学和遗传学角度评估 EF 发展情况。通过使用改良的 Lubina 和 EF He 分级系统计算成纤维细胞的数量来确定纤维化程度。通过液滴数字聚合酶链反应法测量白细胞介素 6（IL-6）、转化生长因子β-1（TGFβ-1）和 mRNA 水平。
纤维状组硬膜外成纤维细胞数量、改良 Lubina 百分比、IL-6 含量和 He 分级率均明显低于双极组和对照组（p ˂ 0.05）。另一方面，三组间 TGFβ-1 值无显著差异（p= 0.525）。
与双极电凝相比，纤维状氧化纤维素在减少 EF 发展方面更有效。
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