Lomber Diskektomi Operasyonu Yapılan Hastalarda Sentetik Kollajen Membran Kullanımının Epidural Fibrozis Gelişimini Önleme Üzerine Etkilerinin MRG Bulguları ile Değerlendirilmesi

Year 2023, Volume: 33 Issue: 3, 299 - 304, 30.06.2023

Mehmet Kaya

https://doi.org/10.54005/geneltip.1248667

Abstract

Özet
Arkaplan/Amaç: Lomber diskektomi yapılan hastalarda dura mater üzerine yerleştirilen sentetik kollajen membranın araknoidit ve fibrozis gelişimini önlemedeki etkisinin manyetik rezonans görüntüleme (MRG) bulguları ile değerlendirilmesi.
Yöntemler: Lomber disk hernisi nedeniyle tek seviyeli unilateral diskektomi uygulanan toplam 40 hasta retrospektif olarak değerlendirildi. Dura üzerine kollajen membran yerleştirilmiş 16 hasta ve dura üzerinde herhangi bir materyal bulunmayan 24 hasta çalışmaya dahil edildi. Kollajen membranı olan ve olmayan hastaların ameliyat sonrası MR görüntüleri incelenerek kullanılan malzemenin araknoidit ve/veya epidural fibrozis ve granülasyon dokusu oluşumunu önlemede etkili olup olmadığı değerlendirildi.
Bulgular: 24 hastanın 9'u kadın (%37,5) ve 15'i erkek (%62,5) kollajen membransız gruptaydı. Kollajen membran grubundaki hastaların dördü (%25) kadın, 12'si (%75) erkekti. Membransız grubun yaş ortalaması 35,47 ± 9,06, membranlı grubun yaş ortalaması 37,40 ± 8,92 idi. MRG bulgularına göre kollajen membranlı 16 hastanın 8'inde (%50) granülasyon dokusu ve epidural fibrozis izlenmezken, 8 (%50) hastada granülasyon dokusu görüldü. Kollajen membranı olmayan 24 hastanın 10'unda (%41,7) granülasyon dokusu izlenmezken, 14'ünde (%58,3) epidural fibrozis ve granülasyon dokusu oluşumu gözlendi. Bu sonuçlara göre tip I kollajen membran kullanımı ile granülasyon dokusu oluşumu arasında istatistiksel olarak anlamlı bir ilişki bulunmadı. (P = 0,604 <0,05). Tip-I kollajen membranı olan hastalarda granülasyon dokusu (%50) ve yokluğu (%50) arasında fark yoktu.
Sonuç: Bu sonuçlara ve MRG bulgularına göre, lomber diskektomide peroperatif tip-I kollajen membran kullanımının granülasyon dokusu veya epidural fibrozis oluşumu üzerinde istatistiksel olarak anlamlı bir etkisinin olmadığı bulundu.

Keywords

lomber disk hernisi, epidural fibrozis, kollajen membran, MRG

The Assessment of the Effects of Synthetic Collagen Membrane Use on the Prevention of Epidural Fibrosis Development in Patients Undergoing Lumbar Discectomy by Magnetic Resonance Imaging Findings

Abstract

Abstract
Bacground/Aims: The aim of study to evaluate the effects of synthetic collagen membrane placed on dura mater on the prevention of arachnoiditis and fibrosis development by magnetic resonance imaging (MRI) findings in patients undergoing lumbar discectomy.
Methods: A total of 40 patients who underwent single level unilateral discectomy for lumbar disc hernia were retrospectively evaluated. Sixteen patients with collagen membranes placed on the dura and 24 patients without any material on the dura were included in the study. Postoperative MRI images of the patients with and without collagen membranes were examined and evaluated whether the material used was effective in preventing arachnoiditis and / or epidural fibrosis and granulation tissue formation.
Results: Nine female patients (37.5%) and 15 male patients (62.5%) of 24 patients were in the collagen membrane-free group. Four of the patients in the collagen membrane group were female (25%) and 12 were male (75%). The mean age of the non-membrane group was 35.47 ± 9.06, and the mean age of the membrane group was 37.40 ± 8.92 years. According to MRI findings, granulation tissue and epidural fibrosis were not observed in 8 (50%) of 16 patients with collagen membranes, whereas granulation tissue was observed in 8 (50%) patients. Granulation tissue was not observed in 10 (41.7%) of 24 patients without collagen membrane, whereas epidural fibrosis and granulation tissue formation was observed in 14 (58.3%). Based on these results, there was no statistically significant relationship between type-I collagen membrane use and granulation tissue formation. (P = 0.604 <0.05). There was no difference between the rate of granulation tissue (50%) and absence (50%) in patients with type-I collagen membranes.
Conclusion: According to these results and MRI findings, it was found that peroperative type-I collagen membrane use in lumbar discectomy did not have a statistically significant effect on granulation tissue or epidural fibrosis formation.

Keywords

lumbar disk herniation, epidural fibrosis, collagen membrane, MRI

References

• Eseoğlu M, Akdemir H. Failed back surgery syndrome in lomber disc herniation: The retrospective analysis of success scorings of epidural fibrosis and recurrent cases in reoperations. European Journal of General Medicine. 2010; 7: 130-135.
• Gasiński P, Radek M, Jóźwiak J, Łyczak P. Peridural fibrosis in lumbar disc surgery--pathogenesis, clinical problems and prophylactic attempts. Neurologia İ Neurochirurgia Polska. 2000; 34: 983-993.
• Karabekir HS, Gocmen-Mas N, Edizer M. Anatomical and surgical perspective to approach degenerative disc hernias. Explicative Cases of Controversial Issues in Neurosurgery: IntechOpen. 2012; 337.
• Kutsal Y, İnanıcı F, Oğuz K, Alanay A, Palaoğlu S. Bel ağrıları. Hacettepe Tıp Dergisi. 2008; 39: 180-193.
• Long DM, BenDebba M, Torgerson WS, Boyd RJ, Dawson EG, Hardy RW, ... & Watts C. Persistent back pain and sciatica in the United States: Patient characteristics. J Spinal Disord. 1996; 9: 40-58.
• Bundschuh CV, Modic MT, Ross JS, Masaryk TJ, Bohlman H. Epidural fibrosis and recurrent disk herniation in the lumbar spine: MR imaging assessment. American Journal of Roentgenology. 1988; 150: 923-932.
• Carragee EJ, Kim DH. A prospective analysis of magnetic resonance imaging findings in patients with sciatica and lumbar disc herniation: correlation of outcomes with disc fragment and canal morphology. Spine. 1997; 22: 1650-1660.
• Cervellini P, Curri D, Volpin L, Bernardi L, Pinna V, Benedetti A. Computed tomography of epidural fibrosis after discectomy: a comparison between symptomatic and asymptomatic patients. Neurosurgery. 1988; 23: 710-713.
• Cooper R, Mitchell W, Illingworth K, Forbes W, Gillespie J, Jayson M. The role of epidural fibrosis and defective fibrinolysis in the persistence of postlaminectomy back pain. Spine. 1991; 16: 1044-1048.
• He Y, Revel M, Loty B. A quantitative model of post-laminectomy scar formation. Effects of a nonsteroidal anti-inflammatory drug. Spine. 1995; 20: 557-563.
• Alkalay RN, Kim DH, Urry DW, Xu J, Parker TM, Glazer PA. Prevention of postlaminectomy epidural fibrosis using bioelastic materials. Spine. 2003; 28: 1659-1665.
• Hui A, Chan Y, Kay R. Syrinx and tuberculoma formation in tuberculous arachnoiditis. Canadian Journal Of Neurological Sciences. 2001; 28: 148-24.
• Gourie-Devi M, Satishchandra P. Hyaluronidase as an adjuvant in the management of tuberculous spinal arachnoiditis. Journal Of The Neurological Sciences. 1991;102:105-11.
• Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism. 2012; 64: 2028-2037.
• Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. The Lancet. 2012; 379: 482-491.
• Kasimcan MO, Bakar B, Aktaş S, Alhan A, Yilmaz M. Effectiveness of the biophysical barriers on the peridural fibrosis of a postlaminectomy rat model: an experimental research. Injury.2011; 42: 778-781.
• Slipman CW, Shin CH, Patel RK, et al. Etiologies of failed back surgery syndrome. Pain Medicine. 2002; 3: 200-214.
• Rodrigues FF, Dozza DC, Oliveira CRD, Castro RGD. Failed back surgery syndrome: casuistic and etiology. Arquivos De Neuro-Psiquiatria. 2006; 64: 757-761.
• Long DM, Filtzer DL, BenDebba M, Hendler NH. Clinical features of the failed-back syndrome. Journal Of Neurosurgery. 1988; 69: 61-71.
• Porchet, F., Lutz, T. W., Gratzl, O., Brotchi, J., Benini, A., Strommer, K. N., ... & Ross, J. S. Clinical assessment of a novel antiadhesion barrier gel: prospective, randomized, multicenter, clinical trial of ADCON-L to inhibit postoperative peridural fibrosis and related symptoms after lumbar discectomy. American Journal Of Orthopedics (Belle Mead, NJ). 1998; 27: 111-120.
• Richter H-P, Kast E, Tomczak R, Besenfelder W, Gaus W. Results of applying ADCON-L gel after lumbar discectomy: The German ADCON-L study. Journal of Neurosurgery: Spine 2001. 95:179-189.
• Petrie J, Ross J. Use of ADCON®-L to inhibit postoperative peridural fibrosis and related symptoms following lumbar disc surgery: a preliminary report. European Spine Journal. 1996; 5:S10-S7.
• Hieb LD, Stevens DL. Spontaneous postoperative cerebrospinal fluid leaks following application of anti-adhesion barrier gel: case report and review of the literature. Spine. 2001; 26: 748-751.
• Songer MN, Ghosh L, Spencer DL. Effects of sodium hyaluronate on peridural fibrosis after lumbar laminotomy and discectomy. Spine (Phila Pa 1976). 1990; 15: 550-554.
• Llado A, Guimera J, Garcia F, Navarro A. Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: an experimental study. European Spine Journal. 1999; 8:138-143.
• DiFazio FA, Nichols JB, Pope MH, Frymoyer JW. The use of expanded polytetrafluoroethylene as an interpositional membrane after lumbar laminectomy. Spine. 1995; 20: 986-991.
• Rodgers KE, Robertson JT, Espinoza T, Oppelt W, Cortese S, Berg RA. Reduction of epidural fibrosis in lumbar surgery with Oxiplex adhesion barriers of carboxymethylcellulose and polyethylene oxide. The Spine Journal. 2003;3: 277-283.
• Nussbaum CE, McDonald JV, Baggs RB. Use of Vicryl (polyglactin 910) mesh to limit epidural scar formation after laminectomy. Neurosurgery. 1990; 26: 649-654.
• Akdemir H, Pasaoglu A, Selcuklu A, Ozturk F, Kurtsoy A. Prevention of adhesions after laminectomy: an experimental study in dogs. Res Exp Med (Berl). 1993;193:39-46.
• Dullerud R, Graver V, Haakonsen M, Haaland AK, Loeb M, Magnæs B. Influence of fibrinolytic factors on scar formation after lumbar discectomy: a magnetic resonance imaging follow-up study with clinical correlation performed 7 years after surgery. Spine. 1998;23:1464-1469.
• Dogulu, F., Kurt, G., Emmez, H., Erdem, O., Memis, L., Baykaner, K., & Ceviker, N. Topical mitomycin C—induced inhibition of postlaminectomy peridural fibrosis in rabbits. Journal of Neurosurgery: Spine. 2003; 99:76-79.
• Sun, Y., Wang, L. X., Wang, L., Sun, S. X., Cao, X. J., Wang, P., & Feng, L. A comparison of the effectiveness of mitomycin C and 5-fluorouracil in the prevention of peridural adhesion after laminectomy. J Neurosurg Spine. 2007; 7:423-428.
• Bozkurt, H., Bektaşoğlu, P. K., Borekci, A., Öztürk, Ö. Ç., Kertmen, H., Eğilmez, R., ... & Gürer, B. Antifibrotic Effect of Boric Acid in Rats with Epidural Fibrosis. World neurosurgery 2019; 122:e989-e94.