J Korean Neurosurg Soc.  2016 May;59(3):250-258. 10.3340/jkns.2016.59.3.250.

Effects of a Temperature-Sensitive, Anti-Adhesive Agent on the Reduction of Adhesion in a Rabbit Laminectomy Model

• Park JW
• Bak KH
• Cho TK
• Chun HJ
• Ryu JI

• KMID: 2192101
• DOI: http://doi.org/10.3340/jkns.2016.59.3.250

Abstract

OBJECTIVE
A common cause of failure in laminectomy surgery is when epidural, peridural, or perineural adhesion occurs postoperatively. The purpose of this study is to examine the efficacy of a temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG®, as a mechanical barrier for the prevention or reduction of peridural scar adhesion in a rabbit laminectomy model.
METHODS
Twenty-six mature rabbits were used for this study. Each rabbit underwent two separate laminectomies at lumbar vertebrae L3 and L6, left empty (the control group) and applied 2 mL of the TSAA agent (the experimental group), respectively. Invasive scar formation or inflammation after laminectomy was quantitatively evaluated by measuring the thickness of the dura, the distance from the surface of dura to the scar tissues, the number of inflammatory cells in the scar tissues at the laminectomy site, and the concentration of collagen in histological sections.
RESULTS
At 6 weeks postsurgery, the dura was significantly thinner and the distance from the surface of dura to the scar tissues was greater in the experimental group than in the control group (p=0.04 and p=0.01). The number of inflammatory cells was not significantly different in the two groups (p=0.08), although the mean number of inflammatory cells was relatively lower in the experimental group than in the control group.
CONCLUSION
The current study suggests that the TSAA agent, Guardix-SG®, could be useful as an interpositional physical barrier after laminectomy for the prevention or reduction of adhesion.

Keyword

Laminectomy; Epidural fibrosis; Epidural adhesion; Anti-adhesive agent

MeSH Terms

Cicatrix
Collagen
Inflammation
Laminectomy*
Lumbar Vertebrae
Rabbits
Collagen

Figure

• 

  Fig. 1 Phase transition. A : The temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG® is a solution at 20℃ and a gel at 30℃. B : Warming (above 25℃) induces the phase transition to the gel form. Sol : solution, LCST : lower critical solution temperature.

• 

  Fig. 2 Measurement of the thickness of the dura (µm) using a histological section (hematoxylin and eosin staining) from a laminectomy site six weeks after operation.

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  Fig. 3 Measurement of the distance from the surface of dura to the scar tissues (µm) using a histological section (hematoxylin and eosin staining) of a laminectomy site six weeks after operation.

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  Fig. 4 Counting the number of inflammatory cells in the scar tissues (No. of inflammatory cells/mm2) using a histological section (hematoxylin and eosin staining) of a laminectomy site six weeks after operation (black arrow indicates inflammatory cells).

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  Fig. 5 Measurement of the concentration of collagen (%/mm2) using a histological section (Masson trichrome staining) of a laminectomy site six weeks after operation (Asterisk indicates fibrosis by collagen).

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  Fig. 6 Histological sections (hematoxylin and eosin staining) of the laminectomy site six weeks after the operation showing the dura and adhesion scar tissue in the TSAA agent treatment group (A) and untreated group (B). TSAA : temperature-sensitive, anti-adhesive agent.

• 

  Fig. 7 Differences in postoperative adhesion between the TSAA agent, Guardix-SG® treatment group and untreated group for the thickness of the dura (µm) (A), the distance from the surface of dura to the scar tissues (µm) (B), the number of inflammatory cells in the scar tissues at the site of laminectomy (No. of inflammatory cells/mm2) (*no significant difference) (C), and the concentration of collagen (%/mm2) (D). TSAA : temperature-sensitive, anti-adhesive agent.

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