Yan Taoxu, Cheng Junyao, He Qing, Wang Yifan, Zhang Chuyue, Huang Da, Liu Jianheng, Wang Zheng
Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China.
College of Biological Science and Engineering, Fuzhou University, Fuzhou 350108, China.
Gels. 2024 Sep 6;10(9):579. doi: 10.3390/gels10090579.
Laminectomy is a commonly performed surgical procedure by orthopedic and neurosurgeons, aimed at alleviating nerve compression and reducing pain. However, in some cases, excessive proliferation of fibrous scar tissue in the epidural space post-surgery can lead to persistent and intractable lower back pain, a condition known as Failed Back Surgery Syndrome (FBSS). The persistent fibrous tissue causes both physical and emotional distress for patients and also makes follow-up surgeries more challenging due to reduced visibility and greater technical difficulty. It has been established that the application of biomaterials to prevent epidural fibrosis post-lumbar surgery is more beneficial than revision surgeries to relieve dural fibrosis. Hydrogel-based biomaterials, with their excellent biocompatibility, degradability, and injectability and tunable mechanical properties, have been increasingly introduced by clinicians and researchers. This paper, building on the foundation of epidural fibrosis, primarily discusses the strategies for the preparation of natural and polymeric biomaterials to prevent epidural fibrosis, their physicochemical properties, and their ability to mitigate the excessive proliferation of fibroblasts. It also emphasizes the challenges that need to be addressed to translate laboratory research into clinical practice and the latest advancements in this field.
椎板切除术是骨科和神经外科医生常用的外科手术，旨在缓解神经压迫并减轻疼痛。然而，在某些情况下，术后硬膜外间隙纤维瘢痕组织过度增生会导致持续且难以治疗的下背痛，即所谓的腰椎手术失败综合征（FBSS）。持续的纤维组织给患者带来身体和情感上的痛苦，并且由于视野受限和技术难度加大，也使得后续手术更具挑战性。已经证实，应用生物材料预防腰椎手术后的硬膜外纤维化比进行翻修手术缓解硬膜纤维化更有益。基于水凝胶的生物材料具有优异的生物相容性、可降解性、可注射性和可调机械性能，已越来越多地被临床医生和研究人员采用。本文在硬膜外纤维化的基础上，主要讨论天然和聚合物生物材料预防硬膜外纤维化的制备策略、它们的物理化学性质以及减轻成纤维细胞过度增殖的能力。它还强调了将实验室研究转化为临床实践需要解决的挑战以及该领域的最新进展。
