Evaluation of Topical Application of Polysaccharide Hemostat and Oxidized Regenerated Cellulose on Epidural Fibrosis in Rats

Abstract

Introduction: Post laminectomy syndrome caused by epidural fibrosis (EF) is an annoying problem for all spinal surgeons. Even after a successful operation EF may mimic previous symptoms giving rise to failed back surgery syndrome (FBSS). Although adhesive barriers are employed to reduce epidural scarring, whether or not hemostatic agents influence EF is yet not clear.

Objectives: To elucidate the effects of commonly used hemostatic agents in neurosurgery on epidural fibrosis after laminectomy on rats.

Methods: This experimental study involving rats after laminectomy, an agent known to decrease EF ADCON (R)-L was compared with polysaccharide hemostat (SealFoam (R)) and oxidized regenerated cellulose (Surgicel (R)). 32 Sprague-Dawley rats were divided into four groups, all had laminectomies and their epidural space was examined after 45 days.

Results: When compared with the control group, both SealFoam (R) and Surgicel (R) had a decreased grade of EF which was statistically significant (p=0.001). Although not statistically significant when compared with ADCON (R)-L, these agents had similar effects on reducing epidural fibrosis.

Conclusion: Hemostatic agents are commonly used in spine surgeries. Post operative local hematoma increases epidural fibrosis thus pushing surgeons toward using more agents and leaving them behind. This study shows that polysaccharide hemostat and oxidized regenerated cellulose do not enhance but decrease epidural fibrosis following laminectomy in rats, suggesting that it is not necessary to remove these agents from the surgery field after achieving homeostasis during spinal surgery.