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Efficacy of topical cross‐linked hyaluronic acid hydrogel in preventing post laminectomy/laminotomy fibrosis in a rat model
Author(s) -
Wu ChengYi,
Huang YiHung,
Lee JungShun,
Tai TaWei,
Wu PoTing,
Jou IMing
Publication year - 2016
Publication title -
journal of orthopaedic research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.23001
Subject(s) - laminotomy , laminectomy , medicine , dura mater , spinal canal , subarachnoid space , hyaluronic acid , surgery , epidural space , spinal cord , pathology , anatomy , cerebrospinal fluid , psychiatry
Post‐laminectomy/laminotomy epidural fibrosis (EF) has been implicated as an important cause of failed back syndrome (FBS). The various clinical approaches used to control EF yield mixed outcomes. Cross‐linked hyaluronic acid hydrogel (cHA) was synthesized to increase mechanical stability and residence time. We evaluated the therapeutic attenuation of proliferative EF in laminectomy/laminotomy groups treated and not treated with cHA. A bilateral T11‐L1 total laminectomy or unilateral T12 laminotomy was done on four groups ( n = 10 each) of Sprague‐Dawley rats and then histologically examined 2 months post‐surgery: (I) laminectomy group treated with and (II) not treated with cHA, (III) laminotomy group treated with and (IV) not treated with cHA. The grade of EF, the diameters within the spinal canal, dura mater thickness, and the area of the epidural space, subarachnoid space, and conus medullaris space were assessed. The cHA‐treated subgroups (I, III) had a significantly lower grade of EF, thinner dura mater, and larger epidural and subarachnoid spaces than did the control subgroups (II, IV) ( p < 0.05). The cHA formed a solid interpositional membrane barrier that prevented invasive fibrosis, and also helped reduce pathological changes to the adjacent structures. In conclusion, topically applied cHA is effective for reducing EF. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:299–306, 2016.