title: Efficacy of topical cross-linked hyaluronic acid hydrogel in preventing post laminectomy/laminotomy fibrosis in a rat model.
abstract: 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.
authors.affiliation: Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.|Department of Orthopedics, Chia Yi Christian Hospital, Chia Yi, Taiwan.
authors.forename: Cheng-Yi
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.|Department of Orthopedics, Chia Yi Christian Hospital, Chia Yi, Taiwan.
authors.forename: Yi-Hung
authors.initials: YH
authors.lastname: Huang
authors.affiliation: National Cheng Kung University Hospital, Surgery, Division of Neurosurgery, Tainan, Taiwan.
authors.forename: Jung-Shun
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Ta-Wei
authors.initials: TW
authors.lastname: Tai
authors.affiliation: Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Po-Ting
authors.initials: PT
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Jou
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D004388:Dura Mater / Q000473:pathology; D055111:Failed Back Surgery Syndrome / Q000517:prevention & control*; D005355:Fibrosis / Q000517:prevention & control; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007796:Laminectomy; D008297:Male; D011897:Random Allocation; D017207:Rats, Sprague-Dawley; D013115:Spinal Canal / Q000473:pathology*; D055675:Viscosupplements / Q000008:administration & dosage*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid
keywords: cross-linked hyaluronic acid hydrogel (cHA); epidural fibrosis (EF); laminectomy; laminotomy; spine