The Preventive Effect of Decorin on Epidural Fibrosis and Epidural Adhesions After Laminectomy

Abstract

Laminectomy is commonly performed to treat degenerative spinal diseases by reducing compression on the spinal cord and nerve roots. The postoperative epidural fibrosis and epidural adhesions may result in failed back surgery syndrome, which is characterized by the symptoms of lower back pain or leg pain. There is currently no satisfactory treatment for this complication. The pathological processes of epidural fibrosis and epidural adhesions are relevant to the proliferation of fibroblasts, transdifferentiation of fibroblasts into myofibroblasts, and the excessive deposition of extracellular matrix (ECM) protein. According to reports, transforming growth factor-β1 (TGF-β1) played a vital role in the development of fibrosis by promoting aforementioned processes. Decorin, an endogenous proteoglycan and natural inhibitor of TGF-β1, has exhibited prominent anti-fibrosis activity in various scar formation and fibrosis models of many organs. However, the preventive effect of decorin on epidural fibrosis and epidural adhesions requires further investigation. Here, we investigated the therapeutic effects and potential mechanisms of decorin on epidural fibrosis and epidural adhesions. Our results indicated that decorin could significantly suppress the TGF-β1-induced proliferation, transdifferentiation, and extracellular matrix production in primary fibroblasts. Furthermore, Smad2/3 signaling pathway had been demonstrated to be involved in the preventive effect of decorin. Moreover, administration of decorin in vivo could notably inhibit epidural fibrosis and epidural adhesions after laminectomy. To date, there is no approved therapy to target TGF-β1 for the treatment of epidural fibrosis and epidural adhesions after laminectomy. Our research proved the anti-fibrosis effect of decorin, which may provide an effective and promising treatment for epidural fibrosis and epidural adhesions.

Establishments and Evaluations of Post‐Operative Adhesion Animal Models

“…For example, laminectomy is often used to treat degenerative spinal disease to reduce compression of the spinal cord and nerve roots. [ 63 ] However, epidural adhesions and scar formation caused by post‐operative epidural fibrosis can restrict nerve root movements and cause lower back pain or leg pain, that is, “Failed Back Surgery Syndrome,” with an incidence of 6% to 15%. [ 63,64 ]…”

“…[ 63 ] However, epidural adhesions and scar formation caused by post‐operative epidural fibrosis can restrict nerve root movements and cause lower back pain or leg pain, that is, “Failed Back Surgery Syndrome,” with an incidence of 6% to 15%. [ 63,64 ]…”

“…Other different methods for constructing animal adhesion models. a) Thyroidectomy, [ 75 ] b) hepatectomy, [ 78 ] and c) laminectomy [ 63 ] are methods of surgical excision to cause adhesions between the excised remaining tissue and the surrounding tissue. d) Abdominal wall defect [ 82 ] and e) pericardial defect [ 61 ] are methods of tissue defect that make the organs lose their original protection and produce adhesions.…”

“…Reproduced under terms of the Creative Commons CC BY license. [ 63 ] Copyright 2020, The Authors, published by Frontiers. g) Thyroid adhesions.…”

“…In the spinal adhesion model, the formation of severe scar tissue on the dura was observed after 4 weeks, making it difficult to dissect and separate (Figure 6f). [ 63 ] Post‐partial thyroidectomy adhesion model with extensive and severe adhesions around the thyroid gland observed after 3 weeks (Figure 6g). [ 75 ] After 9 days of establishing uterine adhesions in rats by curettage, a stiff and distorted uterus can be seen.…”