Experimental Model of Intervertebral Disk Mediated Postoperative Epidural Fibrosis

Abstract

Background: Postoperative epidural fibrosis (EF) after lumbar discectomy is the most common and at the same time controversial issue. Purpose: The etiology and pathogenesis creates a lot of discussion and selection of methods of treatment and prevention continues. Methods: L_IV laminectomy with dura mater (DM) exposition was done in 24 rats, and then, 0.3 ml of elements of suspension of autologous intervertebral disk was implicated on DM. As autologous intervertebral disk, we used the intervertebral disk from amputated tail. In all the animals, incisions were closed with 3/0 Vicryl. EF was examined. Fibroblast cell density was calculated in each field at ×40 magnification: Grade 1 - fewer than 100 fibroblasts in each field; Grade 2 - 100-150 fibroblasts in each field; Grade 3 - more than 150 fibroblasts in each field. Results: Based on histological results, we confirmed our model of experiment. On the 30th day of evaluation, there were significant histological evidences of postoperative epidural adhesions in experimental animals, which included the obliteration of epidural space, the presence of adhesions in the dura and nerve roots, the restructuring of the yellow ligament, bone sclerosis, excessive appearance of fibrous tissue around the autologous intervertebral disk tissue that applied on the DM. Conclusion: In our work, we describe a new experimental model, where the elements of autologous intervertebral disk play the role of inflammation trigger, which cause postoperative scar and EF.

Inflammation by activated macrophage‐like THP‐1 cells increases human dura mater cell adhesion with alteration of integrin α2β1 and matrix metalloproteinase

“…Because fibroblast adhesion and the combined cellular response contribute to various aspects of wound healing, many studies have been conducted to clarify the adhesion mechanism of fibroblasts in these tissues. Mechanisms including enhanced collagen synthesis by fibroblasts that migrated from paraspinal muscles, inflammation triggered by intervertebral disc fibroblasts, and activated interleukin‐6 expression due to angiopoietin‐like protein 2 binding in ligamentum flavum fibroblasts have been proposed …”

“…Mechanisms including enhanced collagen synthesis by fibroblasts that migrated from paraspinal muscles, inflammation triggered by intervertebral disc fibroblasts, and activated interleukin-6 expression due to angiopoietin-like protein 2 binding in ligamentum flavum fibroblasts have been proposed. 12,13 Because wound healing in epidural tissue is closely linked to the reaction to inflammation in dura mater cells, several efforts have been made to investigate this relationship. Studies using mini-pigs and rabbits revealed that most cultured dura mater cells are fibroblasts.…”

Impact of sorafenib on epidural fibrosis: An immunohistochemical study

“…Secondary operations required because of EF are both challenging and have a high complication rate[ 1 , 3 , 4 ]. Braverman et al[ 40 ] reported a success rate of only 30%-35% in operations performed by them to correct EF and observed adverse results in 10%-20% of cases.…”

“…EF causes reoccurrence of symptoms because of post-operation nerve root tensioning or compression[ 2 ]. A second operation is often required to remove scar tissue, and it is both difficult and has a high rate of complications[ 1 , 3 , 4 ]. A majority of authors believe that to avoid surgical treatment, EF should be prevented before it occurs[ 5 , 6 ].…”

Toll-Like Receptor 9 Promotes Survival in SERCA2a KO Heart Failure Mice

“…Target genes were amplified using the Power SYBR® Green Master Mix (Invitrogen Life Technologies Corporation, Carlsbad, CA) and the Applied Biosystems 7900HT Fast Real-Time PCR System. Target gene expression was quantified using the relative standard curve method [ 19 ], using a standard curve generated with serial dilution (1 : 5) of a pool of aliquots of sample cDNA, and subsequently normalized to glyceraldehyde 3-phosphate dehydrogenase (GAPDH) gene expression. Primers, designed to span exon-exon boundaries to avoid amplification of genomic DNA, were used for analyzing established parameters of HF and markers of fibrosis.…”