The role of mitomycin C in reducing recurrence of epidural fibrosis after repeated operation in a laminectomy model in rats.

OBJECT Extensive peridural fibrosis after lumbar spine surgery may contribute to poor outcome and recurrent symptoms leading to repeated operation. Secondary procedures are considerably hampered by the presence of scar tissue. Moreover, after excision of the peridural scar, the fibrous tissue may recur, leading to unsuccessful surgical outcome. Mitomycin C (MMC), an alkylating antibiotic substance isolated from Streptomyces caespitosus, potentially suppresses fibroblast proliferation after surgical intervention. The authors investigated the effect of MMC on the reformation of epidural fibrosis in a laminectomy model in rats. METHODS Twenty-four Wistar rats underwent a repeated lumbar laminectomy 3 months after the first operation. In 12 rats, MMC in a concentration of 1 mg/ml was locally applied to the laminectomy site. No treatment was performed in the control group of the other 12 rats. All rats underwent clinical evaluation. Mobility ratings and any evidence of neurological deficit were recorded. Twelve weeks after the second operation, the animals were killed for histological examination. The extent of epidural fibrosis and dural adherence was evaluated. All MMC-treated animals showed reduced epidural scarring, compared with the control group. In nine MMC-treated rats (75%), dural adhesions were moderate. In contrast, all control sites showed dense epidural fibrosis with marked dural adherence. No side effects of the treatment were observed. CONCLUSIONS In this experimental study, MMC in a concentration of 1 mg/ml locally applied significantly reduced recurrence of epidural fibrosis and dural adhesions without any side effects after repeated spinal surgery in a laminectomy model in rats.

[1]  S. Gray,et al.  Time and Dose Effects of Mitomycin C on Extracellular Matrix Fibroblasts and Proteins , 2005, The Laryngoscope.

[2]  T. Kosaka,et al.  Hyperthermo-chemotherapy combined with cytoreductive surgery for the treatment of gastric cancer with peritoneal dissemination , 1991, World Journal of Surgery.

[3]  C. Botana,et al.  Reoperation after lumbar disc surgery: Results in 130 cases , 2005, Acta Neurochirurgica.

[4]  F. Raiskup,et al.  Mitomycin C for pterygium: long term evaluation , 2004, British Journal of Ophthalmology.

[5]  O. Güven,et al.  Effect of Sagittal Plane Deformity of the Lumbar Spine on Epidural Fibrosis Formation After Laminectomy: An Experimental Study in the Rat , 2004, Spine.

[6]  H. Baba,et al.  Revision surgery for lumbar disc herniation , 1995, International Orthopaedics.

[7]  C. Wedekind,et al.  Mitomycin C in preventing spinal epidural fibrosis in a laminectomy model in rats. , 2004, Journal of neurosurgery.

[8]  H. V. Crock,et al.  Re-exploration of the lumbar spine following simple discectomy: a review of 23 cases , 2004, European Spine Journal.

[9]  H. Alaranta,et al.  Severe sciatica: a 13-year follow-up of 342 patients , 2004, European Spine Journal.

[10]  K. Swartz,et al.  Recurrent lumbar disc herniation. , 2003, Neurosurgical focus.

[11]  R. Dullerud,et al.  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 , 1998, Spine.

[12]  P. Grané,et al.  The post-operative lumbar spine : A radiological investigation of the lumbar spine after discectomy using MR imaging and CT , 1998 .

[13]  N. Obuchowski,et al.  Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. ADCON-L European Study Group. , 1996, Neurosurgery.

[14]  A. Moerman,et al.  Relevance of Epidurography and Epidural Adhesiolysis in Chronic Failed Back Surgery Patients , 1995, The Clinical journal of pain.

[15]  T. Bernard.  Using Computed Tomography/Discography and Enhanced Magnetic Resonance Imaging to Distinguish Between Scar Tissue and Recurrent Lumbar Disc Herniation , 1994, Spine.

[16]  P. Lewis,et al.  Lumbar diskectomy for recurrent disk herniation. , 1994, Journal of spinal disorders.

[17]  L. Herron.  Recurrent lumbar disc herniation: results of repeat laminectomy and discectomy. , 1994, Journal of spinal disorders.

[18]  B. Jonsson,et al.  Repeat decompression of lumbar nerve roots. A prospective two-year evaluation , 1993 .

[19]  C. Michelsen,et al.  Revision Surgery for Failed Back Surgery Syndrome , 1992, Spine.

[20]  M. Jayson,et al.  The Role of Epidural Fibrosis and Defective Fibrinolysis in the Persistence of Postlaminectomy Back Pain , 1991, Spine.

[21]  M. Jayson,et al.  Retained surgical swab debris in post-laminectomy arachnoiditis and peridural fibrosis. , 1988, The Journal of bone and joint surgery. British volume.

[22]  B. Weir,et al.  Long-term prospective study of lumbosacral discectomy. , 1987, Journal of neurosurgery.

[23]  I. Søgaard,et al.  Sciatica caused by perifibrosis of the sciatic nerve. , 1986, The Journal of bone and joint surgery. British volume.

[24]  J. Siegfried,et al.  Lumbosacral Spinal Fibrosis (Spinal Arachnoiditis): Its Diagnosis and Treatment by Spinal Cord Stimulation , 1983, Spine.

[25]  E. Siqueira,et al.  Fibrosis of the dura mater. A cause of "failed back" syndrome. , 1983, Surgical neurology.

[26]  K. Heithoff,et al.  Causes of failure of surgery on the lumbar spine. , 1981, Clinical orthopaedics and related research.

[27]  C. Ficat,et al.  Postoperative Lumbar Epiduro-Arachnoiditis: Diagnostic and Therapeutic Aspects , 1980, Spine.

[28]  C. Fager,et al.  Analysis of Failures and Poor Results of Lumbar Spine Surgery , 1980, Spine.

[29]  R. Rothman,et al.  Results of surgical intervention in the symptomatic multiply-operated back patient. Analysis of sixty-seven cases followed for three to seven years. , 1979, The Journal of bone and joint surgery. American volume.

[30]  C. Ficat,et al.  Repeat Surgery After Disc Excision , 1978, Spine.

[31]  J. Johnston,et al.  Microscopic Lysis of Lumbar Adhesive Arachnoiditis , 1978, Spine.

[32]  R. Lehman,et al.  Reoperation after lumbar intervertebral disc surgery. , 1978, Journal of neurosurgery.

[33]  G. Thomalske,et al.  Critical Comments on a Comparison of Two Series (1000 PatientsEach) of Lumbar Disc Surgery , 1977 .