Mechanical barriers and transforming growth factor beta inhibitor on epidural fibrosis in a rabbit laminectomy model

Albiñana-Cunningham, Juan N.; Ripalda‐Cemboráin, Purificación; Labiano, Tania; Echeveste, José; Granero‐Moltó, Froilán; Alfonso-Olmos, Matías

doi:10.1186/s13018-018-0781-6

Cited by 12 publications

(12 citation statements)

References 20 publications

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“…By contrast, revision surgery is complicated by dura that is adherent to the surrounding tissues secondary to increased transforming growth factor-b expression, which causes epidural fibrosis. 19 Failure to account for and transect these adhesions during decompression of the thecal sac leads to increased tension on the thecal sac during retraction, increasing the risk for formation of a dural rent.…”

Section: Prior Investigations Of Durotomy Risk Factorsmentioning

confidence: 99%

Incidental durotomy: predictive risk model and external validation of natural language process identification algorithm

Ehresman

Pennington

Karhade

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEIncidental durotomy is a common complication of elective lumbar spine surgery seen in up to 11% of cases. Prior studies have suggested patient age and body habitus along with a history of prior surgery as being associated with an increased risk of dural tear. To date, no calculator has been developed for quantifying risk. Here, the authors’ aim was to identify independent predictors of incidental durotomy, present a novel predictive calculator, and externally validate a novel method to identify incidental durotomies using natural language processing (NLP).METHODSThe authors retrospectively reviewed all patients who underwent elective lumbar spine procedures at a tertiary academic hospital for degenerative pathologies between July 2016 and November 2018. Data were collected regarding surgical details, patient demographic information, and patient medical comorbidities. The primary outcome was incidental durotomy, which was identified both through manual extraction and the NLP algorithm. Multivariable logistic regression was used to identify independent predictors of incidental durotomy. Bootstrapping was then employed to estimate optimism in the model, which was corrected for; this model was converted to a calculator and deployed online.RESULTSOf the 1279 elective lumbar surgery patients included in this study, incidental durotomy occurred in 108 (8.4%). Risk factors for incidental durotomy on multivariable logistic regression were increased surgical duration, older age, revision versus index surgery, and case starts after 4 pm. This model had an area under curve (AUC) of 0.73 in predicting incidental durotomies. The previously established NLP method was used to identify cases of incidental durotomy, of which it demonstrated excellent discrimination (AUC 0.97).CONCLUSIONSUsing multivariable analysis, the authors found that increased surgical duration, older patient age, cases started after 4 pm, and a history of prior spine surgery are all independent positive predictors of incidental durotomy in patients undergoing elective lumbar surgery. Additionally, the authors put forth the first version of a clinical calculator for durotomy risk that could be used prospectively by spine surgeons when counseling patients about their surgical risk. Lastly, the authors presented an external validation of an NLP algorithm used to identify incidental durotomies through the review of free-text operative notes. The authors believe that these tools can aid clinicians and researchers in their efforts to prevent this costly complication in spine surgery.

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Section: Prior Investigations Of Durotomy Risk Factorsmentioning

confidence: 99%

Incidental durotomy: predictive risk model and external validation of natural language process identification algorithm

Ehresman

Pennington

Karhade

et al. 2020

Journal of Neurosurgery: Spine

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show abstract

“…The compression and tethering might cause pain, and the fibrosis and adhesions might prevent injectate delivery into the epidural space [ 9 , 18 ]. Epidural fibrosis has been reported in animal laminectomy models [ 22 , 23 ]. The presence of fibrosis increases the re-operation time and the risk of dural tears [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Epidural fibrosis has been reported in animal laminectomy models [ 22 , 23 ]. The presence of fibrosis increases the re-operation time and the risk of dural tears [ 22 ]. Ozturk and colleagues [ 19 ] described an arachnoid membrane becoming thickened and adherent to the dura mater after total lumbar laminectomy in a rat model.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome

Lee

Sim

Kim

et al. 2020

JCM

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Persistent or recurrent back and leg pain following spinal surgery, known as failed back surgery syndrome (FBSS), significantly limits daily life activities. A lumbar epidural injection can reduce adhesions, inflammation, and nerve compression, although the epidural space can be distorted due to dura mater and epidural tissues changes after spinal surgery. This study analyzed subdural injection during lumbar epidural injection in FBSS patients. We retrospectively analyzed data from 155 patients who received a lumbar interlaminar epidural injection to manage FBSS. We grouped the patients based on the injected contrast medium appearance in the subdural (group S) or epidural spaces (group E) in fluoroscopic contrast images. Demographic, clinical, surgical and fluoroscopic data were recorded and evaluated, as were the pain scores before and after injection. There were 59 patients (38.1%) in the subdural group. Injection distance from the surgery level differed between the groups. Risk of subdural injection at level 1 distance from the surgery level had an odds ratio of 0.374, and at level ≥2, it was 0.172, when compared to level 0. Subdural incidence differed with the distance from surgical site. Physicians should strive to reduce subdural incidence when the injection is planned at surgery site in FBSS.

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“…З огляду на багатофакторний патогенез епідурального фіброзу, для його профілактики та лікування запропоновано різноманітні підходи: як консервативні (неінвазивні та інвазивні), так і хірургічні [4,7,[17][18][19][20][21][22][23][24][25][26], але вивчення їх ефективності свідчить про необхідність подальших пошуків шляхів вирішення цієї проблеми. Одним з найперспективніших з них нині є застосування бар'єрних біологічних матеріалів (автологічних тканин і полімерів), які відокремлюють оголену тверду мозкову оболонку від навколишніх тканин, мінімізуючи фрикційний ефект [7,22].…”

Section: вступunclassified

The comparative analysis of MRI data in the early period after lumbar microdiscectomies with epidural injection of polyacrylamide hydrogel

Pedachenko¹,

Khyzhnyak²,

Krasylenko³

et al. 2021

Ukr Neurosurg J

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Objective: To perform a comparative analysis of MRI data obtained in the early postoperative period after repeated lumbar microdiscectomies in patients with and without epidural injection of “Nubiplant” polyacrylamide hydrogel (HG). Material and methods: The MRI data of the lumbar spine in the early postoperative period after repeated removal of herniated disc (on the 3-15th day) in 84 (100%) patients were analyzed: 30 (35,7%) patients were injected intraoperatively epidurally with “Nubiplant” HG to prevent epidural fibrosis (main group (MG) and in 54 (64,3%) patients the HG was not injected (control group (CG). Results: Comparative analysis of MRI data on the 3-15th day after surgery showed that the frequency of epidural edema and hemorrhage signs within the postoperative area in the MG was significantly lower as compared to the CG (p = 0,0444 and p = 0,0288 respectively). To assess the accuracy of the epidural administration of an artificial biopolymer Nubiplant during lumbar microdiscectomy, in the early postoperative period the following MRI criteria could be helpful: i) absence of the dural sac deformation and dislocations of the spinal root; ii) well-defined margin of the adjacent spinal root; iii) homogeneous MRI signals of the Nubiplant zone; iv) absence of Nubiplant areas outside the postoperative area; v) sufficient sectoral coverage of the adjacent root with epidurally administered Nubiplant (optimally >1800). Nubiplant” HG in the patients of the MG was evaluated, and MRI criteria for assessing the correctness of its introduction were proposed. Conclusions: In the early period after repeated lumbar microdiscectomies (on the 3-15th day), intraoperative epidural injection of “Nubiplant” HG was accompanied by a significant decrease of epidural edema and hemorrhage signs within the postoperative area. The proposed criteria of correctness of HG “Nubiplant” introduction allow unifying the approaches in radiological assessment of this patients.

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Mechanical barriers and transforming growth factor beta inhibitor on epidural fibrosis in a rabbit laminectomy model

Cited by 12 publications

References 20 publications

Incidental durotomy: predictive risk model and external validation of natural language process identification algorithm

Incidental durotomy: predictive risk model and external validation of natural language process identification algorithm

Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome

The comparative analysis of MRI data in the early period after lumbar microdiscectomies with epidural injection of polyacrylamide hydrogel

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