Reduction in postlaminectomy epidural adhesions in sheep using a fibrin sealant‐based medicated adhesion barrier

Abstract

Epidural adhesion formation is believed to be a central governing factor in the prevalence of pain after spinal surgery and is regarded as being the primary instigator of neural tethering, leading to complications during revision surgery. In this study, we assess the effectiveness and safety of fibrin sealant supplemented with tributyrin, termed Medicated Adhesion Barrier (MAB), as an alternative means of reducing the incidence of posterior spinal epidural adhesion formation. Laminectomy defects in sheep were treated with MAB, fibrin sealant alone, ADCONGel, or remained untreated. At 12 weeks postoperatively, the extent of fibrosis and epidural adhesion formation was evaluated using magnetic resonance imaging (MRI), peel-off testing, and histological examination. Initial invitro analysis revealed that tributyrin was retained in fibrin gel in a time-dependent manner and was an effective inhibitor of fibroblast proliferation. Treatment of sheep with MAB significantly reduced both the prevalence (p < 0.05) and tenacity (p < 0.05) of epidural adhesions. The effectiveness of MAB in preventing epidural adhesions was found to be comparable with that of ADCONGel. No adverse events were reported after the use of MAB. The MAB preparation seems to be an effective resorbable barrier for the prevention of epidural adhesions.

To what extent topical application of cova&#8482; and tisseel® cause spinal peridural fibrosis? comparison with adcon® gel: an experimental study in rat model.

“…Novel hemostatic agents such as fibrin sealants, fibrin patches and gelatin-thrombin matrix sealants that work independently of the coagulation cascade are available for neurosurgical procedures. Fibrin sealants and fibrin patches seem to have more of a role within neurosurgery in treating or preventing CSF leak (10,19,24).…”

“…CSF leakage may cause serious problems such as persistent headaches, meningitis and intracranial subdural hematomas. Surgical management of leakage is commonly closure of the dural tear by means of direct surgical repair techniques with sutures, muscle, fascial grafts, other patch grafts, fibrin glues, fibrin sealants and soft or suturable microfibrillar collagen membranes used as a barrier (19,24).…”

“…Tisseel ® is a fibrin sealant that is used as an adjunct to hemostasis when control of bleeding by conventional surgical techniques, such as suture, ligature, and cautery, is ineffective or impractical (19,24,32). It received Food and Drug Administration (FDA) approval for hemostasis at 1998 (32).…”

Original article Nanofiber nets in prevention of cicatrisation in spinal procedures. Experimental study

“…Artificial materials used in neurosurgical procedures can cause a disadvantageous granulomatous process [1]. Experimental studies in recent years have also used hyaluronic acid, hemostatic gelatin (Floseal; Baxter International Inc.), DuraGen, monoclonal antibodies, mitomycin and aprotinin, TachoComb, bioresorbable films and hydrogels [3,5,7,8,19,22,25,34,40].…”

“…Artificial materials used in neurosurgical procedures can cause a disadvantageous granulomatous process [1]. Experimental studies in recent years have also used hyaluronic acid, hemostatic gelatin (Floseal; Baxter International Inc.), DuraGen, monoclonal antibodies, mitomycin and aprotinin, TachoComb, bioresorbable films and hydrogels [3,5,7,8,19,22,25,34,40].On the other hand, following the Central Nervous System damages the glial scar formation is a reactive cellular process involving astrogliosis [13] and it is the mechanism to protect and begin the healing process in the nervous system. It is known that the absence of the glial scar has been associated with impairments in the repair of the BBB (blood brain barrier) [9].…”