title: Is the use of hemostatic matrix (Floseal) and alkylene oxide copolymer (Ostene) safe in spinal laminectomies? Peridural fibrosis assessment.
abstract: OBJECTIVE
  Failed Back Syndrome (FBS) is unacceptable relief of pain or recurrence of symptoms in patients after spinal surgery, such as laminectomy. One possible cause of FBS is peridural fibrosis (PF). PF is the overproduction of scar tissue adjacent to the dura mater. Bleeding can cause PF after laminectomy. Ostene is an alkylene oxide copolymer material used to stop bleeding from bony surfaces. Floseal is a gelatin thrombin matrix sealant used to assist fibrin formation and to promote coagulation.
  
  
  METHODS
  Total of 32 female Sprague-Dawley rats were evenly allotted to 4 experimental groups: laminectomy only, laminectomy + Ostene (Baxter International, Inc., Deerfield, IL, USA), laminectomy + Floseal (Baxter International, Inc., Deerfield, IL, USA), and laminectomy + Adcon-L (aap Implantate AG, Berlin, Germany). After performing total laminectomy, agents were placed over dura mater. Spinal column of test subjects was harvested 6 weeks after laminectomy. Histopathological examination of samples was based on Masson's trichrome and hematoxylin and eosin staining. PF observed in the groups was graded using system previously described by He et al. Statistically significant p value was defined as p < 0.005.
  
  
  RESULTS
  Present study revealed that Adcon-L, Ostene, and Floseal groups had reduced PF compared with laminectomy only group (p = 0.001). Comparison of Ostene and Floseal groups with Adcon-L group yielded no significant difference.
  
  
  CONCLUSIONS
  Reoperation as result of FBS has greater risk and often has poor outcome; surgeons must take precautions to avoid FBS, such as careful selection of appropriate patient and operation technique. Ostene and Floseal may be applied and left in the operation field safely during laminectomy to reduce occurrence of PF after procedure.
authors.affiliation: Ankara Atatürk Training and Research Hospital, Ankara, Turkey. Electronic address: oktaygurcan@gmail.com.
authors.forename: Oktay
authors.initials: O
authors.lastname: Gurcan
authors.affiliation: Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Ahmet Gurhan
authors.initials: AG
authors.lastname: Gurcay
authors.affiliation: Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Atilla
authors.initials: A
authors.lastname: Kazanci
authors.affiliation: Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
authors.forename: Evrim
authors.initials: E
authors.lastname: Onder
authors.affiliation: Koc University Hospital, Istanbul, Turkey.
authors.forename: Salim
authors.initials: S
authors.lastname: Senturk
authors.affiliation: Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Murad
authors.initials: M
authors.lastname: Bavbek
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004388:Dura Mater / Q000473:pathology*; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D005781:Gelatin Sponge, Absorbable / Q000494:pharmacology*; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects* / Q000379:methods; D008159:Lumbar Vertebrae / Q000601:surgery*; D020442:Poloxamer / Q000494:pharmacology*; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013122:Spinal Diseases / Q000601:surgery*
chemical_list: C411004:FloSeal Matrix; C512681:Ostene; D020442:Poloxamer
keywords: Alkylene oxide copolymer; Failed back syndrome; Hemostatic matrix; Peridural fibrosis; Spinal surgery