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Prevention of Peridural Fibrosis Using a Cyclooxygenase-2 Inhibitor (Nonsteroidal Anti-inflammatory Drug) Soaked in Absorbable Gelatin Sponge: An Experimental Comparative Animal Model

Sae-Jung, Surachai MD; Jirarattanaphochai, Kitti MD, PhD

doi: 10.1097/BRS.0b013e318297c795
Basic Science

Study Design. Experimental study.

Objective. To evaluate the efficacy and safety of peridural parecoxib-soaked absorbable gelatin sponge, and cellulose membrane on peridural fibrosis prevention in an animal model.

Summary of Background Data. Postoperative peridural fibrosis is one of the causes of failed back surgery syndrome. Nonsteroidal anti-inflammatory drugs inhibit the inflammatory response, while an absorbable gelatin sponge or cellulose membrane interposes between the dura and the paraspinal muscle to staunch the surgical bleeding. These mechanisms may prevent peridural fibrosis.

Methods. Forty L5–L6 laminectomized adult Sprague-Dawley rats were randomly allocated into 4 groups. The high parecoxib group received 6 mg of parecoxib soaked into an absorbable gelatin sponge placed over the dura. The low parecoxib group was given 2 mg of parecoxib soaked into an absorbable gelatin sponge. The dura in the cellulose group was covered with a cellulose membrane, while the control group received normal saline drip before surgical wound closure. All rats were killed at 6 weeks for histopathological assessment. The fibroblast density, inflammatory cell density, fibrous adherence, and adverse events were quantified. The obtained results were analyzed statistically.

Results. The respective mean fibroblast density in the high parecoxib, low parecoxib, cellulose, and control groups was 217.77 ± 51.76, 317.51 ± 126.92, 321.80 ± 90.94, and 328.48 ± 73.41 cells/mm2, while the respective mean inflammatory cell density was 539.65 ± 236.52, 910.17 ± 242.59, 1011.84 ± 239.30, and 1261.78 ± 319.68 cells/mm2. The mean fibroblast and inflammatory cell densities of the high parecoxib group were significantly lower than the control. The high parecoxib group also showed statistically less fibrous adherence than low parecoxib, cellulose, and control groups.

Conclusion. The high-dose parecoxib-soaked absorbable gelatin sponge can prevent peridural fibrosis without complications. The low-dose parecoxib and cellulose membrane provided no significant benefit vis-à-vis prevention of peridural fibrosis, as adduced from the lack of any statistically significant difference between the test and control rats.

Level of Evidence: N/A

The experimental comparative animal model studied 40 lumbar laminectomized Sprague-Dawley rats. The 6 mg of parecoxib-soaked absorbable gelatin sponge significantly prevented peridural fibrosis compared with 2 mg of parecoxib-soaked gelatin sponge, an epidural cellulose membrane or normal saline treatment.

From the Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Address correspondence and reprint requests to Surachai Sae-Jung, MD, Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand; E-mail: sursea@kku.ac.th

Acknowledgment date: January 3, 2013. Revision date: March 2, 2013. Acceptance date: April 10, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The PhD in Clinical Science Research Scholarship, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 by Lippincott Williams & Wilkins