Our Summary

This research paper is about a condition called Failed Back Surgery Syndrome (FBSS) where patients still have pain after back or leg surgery. One common cause of this is Epidural Fibrosis (EF), which is basically scarring in the area where the surgery was done. The researchers wanted to see if certain substances, known as hemostatic agents, could help prevent this scarring.

They tested this on rats, where 40 rats were divided into 5 groups. One group had a spinal surgery (laminectomy) and no other treatment, while the other 4 groups had the spinal surgery and then received one of the hemostatic agents. After 45 days, the rats were put to sleep and the level of scarring was measured.

The results showed that three of the four substances tested (oxidized regenerated cellulose, polysaccharide hemostat and hemostatic thrombin-gelatin matrix) were effective in reducing the amount of scarring. However, one substance (chitosan linear polymer) didn’t have a significant effect.

In simpler terms, the study found that certain substances could help reduce scarring after back surgery in rats, which could potentially help prevent ongoing pain in human patients after similar surgeries. This is an early stage study, so more research would be needed to see if the same results could be seen in humans.

FAQs

  1. What is Failed Back Surgery Syndrome (FBSS)?
  2. How did the researchers test the effectiveness of hemostatic agents in reducing scarring after spinal surgery?
  3. What were the findings of the study on the use of hemostatic agents in preventing scarring after spinal surgery?

Doctor’s Tip

A doctor may tell a patient undergoing a spinal laminectomy to discuss with their surgeon the possibility of using hemostatic agents to help reduce scarring and potentially prevent ongoing pain after surgery. It’s important to remember that this research is in the early stages and more studies would be needed to confirm these results in humans.

Suitable For

Patients who have undergone spinal surgery, specifically spinal laminectomy, and are experiencing ongoing pain, particularly as a result of Epidural Fibrosis (EF), may be recommended for this type of treatment. Failed Back Surgery Syndrome (FBSS) patients who have not had success with other treatments may also be considered for spinal laminectomy with the use of hemostatic agents to prevent scarring and potentially reduce pain.

Timeline

Before spinal laminectomy:

  1. Patient experiences chronic back or leg pain that does not improve with conservative treatments such as physical therapy or medication.
  2. Patient undergoes imaging tests such as MRI or CT scan to determine the cause of the pain.
  3. Surgeon recommends spinal laminectomy as a treatment option to relieve pressure on the spinal nerves.

After spinal laminectomy:

  1. Patient undergoes surgery to remove part of the lamina (the bony arch of the vertebra) to relieve pressure on the spinal nerves.
  2. Patient may experience some pain and discomfort immediately after surgery, which is managed with pain medication.
  3. Patient undergoes physical therapy to help strengthen the muscles supporting the spine and improve mobility.
  4. Patient gradually resumes normal activities and may experience a reduction in pain over time.
  5. In some cases, patients may still experience ongoing pain after surgery, known as Failed Back Surgery Syndrome (FBSS), which may be due to complications such as Epidural Fibrosis (EF).

What to Ask Your Doctor

  1. Can a hemostatic agent be used during my spinal laminectomy surgery to help prevent epidural fibrosis and reduce the risk of Failed Back Surgery Syndrome?
  2. What are the potential risks and side effects of using hemostatic agents during spinal surgery?
  3. How long would I need to be monitored or follow up after surgery if a hemostatic agent is used?
  4. Are there any alternative treatments or preventative measures for epidural fibrosis that I should consider?
  5. What is the success rate of using hemostatic agents in preventing epidural fibrosis in human patients compared to the results seen in this study on rats?
  6. How soon after surgery could I expect to see potential benefits from using a hemostatic agent in terms of reduced scarring and pain relief?
  7. Are there any specific factors or characteristics about my case that would make me a good or poor candidate for using a hemostatic agent during my spinal laminectomy surgery?
  8. How does the cost of using a hemostatic agent during surgery compare to the potential benefits in terms of preventing epidural fibrosis and reducing the risk of ongoing pain?
  9. Are there any ongoing clinical trials or research studies investigating the use of hemostatic agents in spinal surgeries for preventing epidural fibrosis that I could consider participating in?
  10. What is the overall prognosis for patients who develop epidural fibrosis after spinal laminectomy surgery, and how could using a hemostatic agent potentially improve my long-term outcomes?

Reference

Authors: Bozkurt I, Kazanci A, Gurcan O, Gurcay AG, Arikok AT, Bavbek M. Journal: Br J Neurosurg. 2023 Apr;37(2):137-141. doi: 10.1080/02688697.2021.1950627. Epub 2021 Jul 10. PMID: 36939282