Inhibition of Peridural Fibrosis after Laminectomy Using Low-dose External Beam Radiation in a Rat Model

Abstract

Low-dose external beam radiation therapy administered before or after laminectomy in a rat model significantly decreases the extent, density, and arachnoidal involvement of peridural fibrosis. This technique may improve the outcome of patients who undergo reoperations for recurrent radicular and/or low back pain after successful lumbar discectomy in whom there is a significant amount of peridural fibrosis.

Alpha-lipoic acid reduces peridural fibrosis after laminectomy of lumbar vertebrae in rabbits

“…Numerous synthetic and natural materials such as, polytetrafluoroethylene, free fat transplantation, protein-based polymer, high-molecular weight hyaluronan, Oxiplex/SP, and DuraGen [20], antineoplastic agents [25], fibrinolytic agents [4], anti-inflammatory agents [9], and low-dose radiation [8] have been evaluated to prevent or reduce postoperative peridural scar formation in both animal and human studies.…”

Anti-adhesive effect of hyaluronate in a rabbit laminectomy model

“…An ideal anti-adhesive agent also needs to be effective, biocompatible, and easily applicable, as well as predictably absorbable. [9] Several candidate anti-adhesive materials and methods have been investigated, including low-dose external beam radiation, [5] mechanical barriers such as fat, [21,22] polylactic acid, [23] Avitene ® (Davol, Inc., Warwick, RI, USA), and Gelfoam ® (Pfizer, Inc., New York, NY, USA), [24] and pharmacological agents such as anti-inflammatory agents, antioxidants, anticoagulants, and fibrinolytics. [25] Results of our study show that HA-based gelatin is an effective and safe anti-adhesion material that can be applied in vivo without any significant adverse effects in an adult rabbit laminectomy model.…”

“…Many materials reportedly have the potential to prevent postoperative peridural adhesion or fibrosis, including physical materials such as barrier gels, Silastic ® sheets (Dow Corning Corp., Midland, MI, USA), and absorbable foams, chemical materials such as nonsteroid anti-inflammatory drugs (NSAIDs), pharmaceuticals, and steroids, and biologic materials such as hyaluronate membranes, cellulose mesh, and free and pedicle fat grafts. [5][6][7][8][9][10] However, the effects of these methods and materials remain questionable due to several extraneous and confounding variables in the experimental designs and various anti-adhesive agents.…”

Significance of the mass-compression effect of postlaminectomy/laminotomy fibrosis on histological changes on the dura mater and nerve root of the cauda equina: an experimental study in rats

“…Epidural fibrosis formation has been associated with the pathogenesis of PNDBP [7][8][9], but this remains controversial [10,11]. Although PLF has mechanical implications with respect to compressing the neural sac, several studies [12][13][14] have used gadolinium-enhanced magnetic resonance imaging (MRI) or computed tomography (CT) to prove no direct correlation with the presence or extent of PLF in patients with and without recurrent sciatic pain after lumbar discectomy.…”