The comparative analysis of MRI data in the early period after lumbar microdiscectomies with epidural injection of polyacrylamide hydrogel
Keywords:lumbar microdiscectomy, MRI, prevention of epidural fibrosis, hydrogel “Nubiplant”
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.
1. Sebaaly A, Lahoud MJ, Rizkallah M, Kreichati G, Kharrat K. Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome. Asian Spine J. 2018 Jun;12(3):574-585. [CrossRef] [PubMed] [PubMed Central]
4. Hayek SM, Helm S, Benyamin RM, Singh V, Bryce DA, Smith HS. Effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome: a systematic review. Pain Physician. 2009 Mar-Apr;12(2):419-35. [CrossRef] [PubMed]
5. Rönnberg K, Lind B, Zoega B, Gadeholt-Göthlin G, Halldin K, Gellerstedt M, Brisby H. Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients. Eur Spine J. 2008 Dec;17(12):1714-20. [CrossRef] [PubMed] [PubMed Central]
7. Zhivotenko AP, Koshkareva ZV, Sorokovikov VA. Prevention of postoperative epidural fibrosis: current status of the issue. Hirurgiâ pozvonočnika (Spine Surgery). 2019 Sep 22;16(3):74–81. [CrossRef]
8. Zhivotenko AP, Sorokovikov VA, Koshkaryova ZV, Negreyeva MB, Potapov VE, Gorbunov AV. Modern ideas about epidural fibrosis (literature review). Acta Biomedica Scientifica. 2017 Nov 28;2(6):27-33. Russian. [CrossRef]
9. Kanamori M, Kawaguchi Y, Ohmori K, Kimura T, Tsuji H, Matsui H. The fate of autogenous free-fat grafts after posterior lumbar surgery: part 2. Magnetic resonance imaging and histologic studies in repeated surgery cases. Spine (Phila Pa 1976). 2001 Oct 15;26(20):2264-70. [CrossRef] [PubMed]
10. Alkalay RN, Kim DH, Urry DW, Xu J, Parker TM, Glazer PA. Prevention of postlaminectomy epidural fibrosis using bioelastic materials. Spine (Phila Pa 1976). 2003 Aug 1;28(15):1659-65. [CrossRef] [PubMed]
11. Quan M, Hwang WH, Kim JH, Kim YY. Analysis of pain markers and epidural fibrosis caused by repeated spinal surgery in Sprague-Dawley rats. BMC Musculoskelet Disord. 2021 Jan 5;22(1):16. [CrossRef] [PubMed] [PubMed Central]
12. Gasiński P, Radek M, Jóźwiak J, Łyczak P. Blizna oponowa w operacjach odcinka ledźwiowego kregosłupa--mechanizm powstawania, problemy kliniczne i próby profilaktyki [Peridural fibrosis in lumbar disc surgery-pathogenesis, clinical problems and prophylactic attempts]. Neurol Neurochir Pol. 2000 Sep-Oct;34(5):983-93. Polish. [PubMed]
13. Fadda A, Oevermann A, Vandevelde M, Doherr MG, Forterre F, Henke D. Clinical and pathological analysis of epidural inflammation in intervertebral disk extrusion in dogs. J Vet Intern Med. 2013 Jul-Aug;27(4):924-34. [CrossRef] [PubMed]
14. Larionov SN, Sorokovikov VA, Erdyneyev KC, Lepekhova SA, Goldberg OA. Experimental Model of Intervertebral Disk Mediated Postoperative Epidural Fibrosis. Ann Neurosci. 2016 Jul;23(2):76-80. [CrossRef] [PubMed] [PubMed Central]
15. Erdyneev KTs, Larionov SN, Lepekhova SA, Goldberg OA, Sorokovikov VA, Sharova TV. [Evaluation of neurological disorders in experimental model of prevention postoperative epidural fibrosis]. Vestnik Burâtskogo gosudarstvennogo universiteta. Medicina i farmaciâ.2013;(12):89-94. Russian.
16. Aydin Y, Ziyal IM, Duman H, Türkmen CS, Başak M, Sahin Y. Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique. Surg Neurol. 2002 Jan;57(1):5-13; discussion 13-4. [CrossRef] [PubMed]
17. Liu KC, Hsieh MH, Yang CC, Chang WL, Huang YH. Full endoscopic interlaminar discectomy (FEID) for recurrent lumbar disc herniation: surgical technique, clinical outcome, and prognostic factors. J Spine Surg. 2020 Jun;6(2):483-494. [CrossRef] [PubMed] [PubMed Central]
18. Choi GJ, Park HK, Kim DS, Lee D, Kang H. Effect of statins on experimental postoperative adhesion: a systematic review and meta-analysis. Sci Rep. 2018 Oct 3;8(1):14754. [CrossRef] [PubMed] [PubMed Central]
19. Kelten B, Erdogan H, Antar V, Sanel S, Tuncdemir M, Kutnu M, Karaoglan A, Orki T. Pentoxifylline Inhibits Epidural Fibrosis in Post-Laminectomy Rats. Med Sci Monit. 2016 Mar 14;22:840-7. [CrossRef] [PubMed] [PubMed Central]
20. Guler S, Akcali O, Sen B, Micili SC, Sanli NK, Cankaya D. EFFECT OF PLATELET-RICH PLASMA, FAT PAD AND DURAL MATRIX IN PREVENTING EPIDURAL FIBROSIS. Acta Ortop Bras. 2020 Jan-Feb;28(1):31-35. [CrossRef] [PubMed] [PubMed Central]
21. Ozturk Y, Bozkurt I, Yaman ME, Guvenc Y, Tolunay T, Bayram P, Hayirli N, Billur D, Erbay FK, Senturk S, Bozkurt G. Histopathologic Analysis of Tamoxifen on Epidural Fibrosis. World Neurosurg. 2018 Mar;111:e941-e948. [CrossRef] [PubMed]
22. Wang H, Sun W, Fu D, Shen Y, Chen YY, Wang LL. Update on biomaterials for prevention of epidural adhesion after lumbar laminectomy. J Orthop Translat. 2018 Mar 7;13:41-49. [CrossRef] [PubMed] [PubMed Central]
23. Geudeke MW, Krediet AC, Bilecen S, Huygen FJPM, Rijsdijk M. Effectiveness of Epiduroscopy for Patients with Failed Back Surgery Syndrome: A Systematic Review and Meta-analysis. Pain Pract. 2020 Dec 4. [CrossRef] [PubMed]
24. Rapčan R, Kočan L, Mláka J, Burianek M, Kočanová H, Rapčanová S, Hess M, Hammond A, Griger M, Venglarčík M, Gajdoš M, Vašková J. A Randomized, Multicenter, Double-Blind, Parallel Pilot Study Assessing the Effect of Mechanical Adhesiolysis vs Adhesiolysis with Corticosteroid and Hyaluronidase Administration into the Epidural Space During Epiduroscopy. Pain Med. 2018 Jul 1;19(7):1436-1444. [CrossRef] [PubMed]
25. Albiñana-Cunningham JN, Ripalda-Cemboráin P, Labiano T, Echeveste JI, Granero-Moltó F, Alfonso-Olmos M. Mechanical barriers and transforming growth factor beta inhibitor on epidural fibrosis in a rabbit laminectomy model. J Orthop Surg Res. 2018 Apr 5;13(1):72. [CrossRef] [PubMed] [PubMed Central]
26. de Divitiis E, Cappabianca P. Preserving the ligamentum flavum in lumbar discectomy: a new technique that prevents scar tissue formation in the first 6 months postsurgery. Neurosurgery. 2007 Dec;61(6):E1340. [CrossRef] [PubMed]
27. Sun Y, Yan LQ, Liang Y, Li XL, Cao XJ, Lu C. Reduction of epidural scar adhesion by topical application of simvastatin after laminectomy in rats. Eur Rev Med Pharmacol Sci. 2015 Jan;19(1):3-8. [PubMed]
28. Wang BB, Xie H, Wu T, Xie N, Wu J, Gu Y, Tang F, Liu J. Controlled-release mitomycin C-polylactic acid film prevents epidural scar hyperplasia after laminectomy by inducing fibroblast autophagy and regulating the expression of miRNAs. Eur Rev Med Pharmacol Sci. 2017 May;21(10):2526-2537. [PubMed]
29. Yao H, Cao Z, Peng L, Liu J, Zhang X, Deng Z. A novel controlled release tetrandrine-loaded PDLLA film: evaluation of drug release and anti-adhesion effects in vitro and in vivo. Drug Deliv Transl Res. 2020 Feb;10(1):13-22. [CrossRef] [PubMed] [PubMed Central]
30. Liu S, Pan G, Liu G, Neves JD, Song S, Chen S, Cheng B, Sun Z, Sarmento B, Cui W, Fan C. Electrospun fibrous membranes featuring sustained release of ibuprofen reduce adhesion and improve neurological function following lumbar laminectomy. J Control Release. 2017 Oct 28;264:1-13. [CrossRef] [PubMed]
31. Xu J, Chen Y, Yue Y, Sun J, Cui L. Reconstruction of epidural fat with engineered adipose tissue from adipose derived stem cells and PLGA in the rabbit dorsal laminectomy model. Biomaterials. 2012 Oct;33(29):6965-73. [CrossRef] [PubMed]
34. Dobran M, Brancorsini D, Costanza MD, Liverotti V, Mancini F, Nasi D, Iacoangeli M, Scerrati M. Epidural scarring after lumbar disc surgery: Equivalent scarring with/without free autologous fat grafts. Surg Neurol Int. 2017 Aug 1;8:169. [CrossRef] [PubMed] [PubMed Central]
36. Rajiv S, Drilling A, Bassiouni A, Harding M, James C, Robinson S, Moratti S, Wormald PJ. Chitosan Dextran gel as an anti adhesion agent in a postlaminectomy spinal sheep model. J Clin Neurosci. 2017 Jun;40:153-156. [CrossRef] [PubMed]
37. Choi HJ, Kim KB, Kwon YM. Effect of amniotic membrane to reduce postlaminectomy epidural adhesion on a rat model. J Korean Neurosurg Soc. 2011 Jun;49(6):323-8. [CrossRef] [PubMed] [PubMed Central]
39. Papanastasiou EI, Theodorou DJ, Theodorou SJ, Pakos EE, Ploumis A, Korompilias AV, Gelalis ID. Association between MRI findings and clinical outcomes in a period of 5 years after lumbar spine microdiscectomy. Eur J Orthop Surg Traumatol. 2020 Apr;30(3):441-446. [CrossRef] [PubMed]
42. Dhagat PK, Jain M, Singh SN, Arora S, Leelakanth K. Failed Back Surgery Syndrome: Evaluation with Magnetic Resonance Imaging. J Clin Diagn Res. 2017 May;11(5):TC06-TC09. [CrossRef] [PubMed] [PubMed Central]
43. Yousem DM, Grossman RI. Neuroradiology The Requistes. 3rd ed. Mosby Inc Elsevier; 2010.
45. van de Kelft EJ, van Goethem JW, de La Porte C, Verlooy JS. Early postoperative gadolinium-DTPA-enhanced MR imaging after successful lumbar discectomy. Br J Neurosurg. 1996 Feb;10(1):41-9. [PubMed]
46. Boden SD, Davis DO, Dina TS, Parker CP, O’Malley S, Sunner JL, Wiesel SW. Contrast-enhanced MR imaging performed after successful lumbar disk surgery: prospective study. Radiology. 1992 Jan;182(1):59-64. [CrossRef] [PubMed]
47. Herrera Herrera I, Moreno de la Presa R, González Gutiérrez R, Bárcena Ruiz E, García Benassi JM. Evaluation of the postoperative lumbar spine. Radiologia. 2013 Jan-Feb;55(1):12-23. English, Spanish. [CrossRef] [PubMed]
How to Cite
Copyright (c) 2021 Eugene G. Pedachenko, Mykhaylo V. Khyzhnyak, Olena P. Krasylenko , Yuriy E. Pedachenko, Olexandr F. Tanaseychuk, Volodymyr A. Kramarenko, Andriy M. Furman, Oksana V. Zemskova
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ukrainian Neurosurgical Journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this Journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the Journal under the terms of Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this Journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form of which it has been published by the Journal (for example, to upload the work to the online storage of the Journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this Journal is included.