Sıçanlarda epidural fibrozisin önlenmesinde, sitikolinin sistemik ve lokal etkinliğinin laminotomi / diskektomi modelinde araştırılması
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Date
2010
Authors
Savran, Mehmet
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Epidural fibrozis lomber disk cerrahisi sonrası ortaya çıkan bel ağrısı ve kök basısı bulgularının nedenlerinden biri ve en önemlisi olarak kabul edilmektedir. Epidural fibrozis aşırı yapışık / fibrotik skar dokusu oluşumu sonucu sinir köküne bası ve sinir kökünün çevre kas ve kemik yapıya yapışması nedeniyle ağrı oluşumuna neden olmaktadır. Epidural fibrozisin muhtemel mekanizmalarını araştırmak ve oluşumunun önlenmesi amacıyla birçok yöntem kullanılmış, fakat epidural fibrozisi önleyen geçerli bir cerrahi teknik veya tedavi henüz bulunamamıştır. Bu tez çalışmasında, lokal ve sistemik uygulanan sitikolinin epidural fibrozis oluşumuna etkisinin araştırılması amaçlandı.Çalışmamızda 64 adet Spraque-Dawley cinsi, 200-250 gr. ağırlığında, dişi sıçan kullanıldı. Sıçanlar üç gruba ayrıldı. 1. grup (kontrol grubu, n=20) da, L4-5 sağ hemilaminotomi ve anuler fenestrasyon yapılan sıçanlara lokal serum fizyolojik, 2. grup (topikal deney grubu, n=20) da aynı cerrahi işlem sonrası topikal sitikolin uygulandı. 3. grup (sistemik deney grubu, n=20) da aynı cerrahi işlem sonrası sistemik (peritoneal) sitikolin uygulandı. Anestezik komplikasyonlara bağlı olarak ölen veya cerrahi işlem sırasında dural yaralanma gelişen 4 sıçan çalışma dışı bırakıldı. Tüm sıçanlar 4. haftanın sonunda dekapite edilip ilgili vertebral kolonlar blok olarak çıkarıldı. Gruplar histopatolojik olarak değerlendirildi ve sonuçlar istatistiksel olarak karşılaştırıldı.Hem topikal hemde sistemik olarak sitikolin uygulanan gruplarda kontrol grubuna oranla epidural fibrozis, dural adezyon, fibroblast hücre yoğunluğu, yabancı cisim reaksiyonu ve medulla spinalis retraksiyonunun belirgin olarak az olduğu izlendi (p<0,001). İki tedavi grubu (grup 2 ve 3) arasında incelenen parametrelerde ise belirgin bir farklılık görülmedi (p>0,05).Bu çalışma, sitikolin'in, operasyon sonrası hem topikal hemde sistemik verimesinin epidural fibrozisin önlenmesinde etkili olabileceğini göstermiştir. Fakat, sitikolin'in etkinliğinin, aynı zamanda klinik çalışmalar ile de desteklenmesi gerekmektedir.
Epidural fibrosis is accepted one of the most important cause of low back pain and root compression after lumbar disc surgery. Pain formation occurs by excessive adhesion/fibrotic scar tissue, which causes compression of the involved nerve root, and tethering of nerve tissue to the surrounding muscle or bone. Its possible mechanisms and patient outcome have been extensively studied but any effective preventive surgical technique or treatment has not been defined yet. In our study, we aimed to investigate the local and systemic effectiveness of citicoline on prevention of epidural fibrosis in a laminotomy dicectomy rat model.64 Sprague-Dawley female rats were used in this study. Rats were divided into three groups. Group 1 (control group, n=20); Underwent L4-5 right sided hemilaminotomy and annular fenestration (discectomy), and 0,9% saline was applied on the surgical area. In Group 2 (topical citicoline group, n=20); citicoline was applied to surgical area after identical surgical procedure. In Group 3 (systemic citicoline group, n=20); citicoline was applied intraperitoneally after identical surgical procedure. 4 rats was excluded due to death dependent on anesthetic complications or dural injury. All rats were decapitated after four weeks and their vertebral colons were removed en bloc. Groups were evaluated histopathological and results were compared with statistically.Compared with control group (group 1), significantly, less epidural fibrosis, dural adhesion, fibroblast cell density, foreign body reaction, and medulla spinalis retraction were observed in groups treated with local and systemic citicoline (groups 2 and 3) (p<0,001). There were no significant differences in any parameters between group 2 (topical citicoline group) and group 3 (systemic citicoline group) (p>0,05).Our study demonstrated that citicoline may be effective for preventing postoperative epidural fibrosis, however its effect should also be supported with clinical studies.
Epidural fibrosis is accepted one of the most important cause of low back pain and root compression after lumbar disc surgery. Pain formation occurs by excessive adhesion/fibrotic scar tissue, which causes compression of the involved nerve root, and tethering of nerve tissue to the surrounding muscle or bone. Its possible mechanisms and patient outcome have been extensively studied but any effective preventive surgical technique or treatment has not been defined yet. In our study, we aimed to investigate the local and systemic effectiveness of citicoline on prevention of epidural fibrosis in a laminotomy dicectomy rat model.64 Sprague-Dawley female rats were used in this study. Rats were divided into three groups. Group 1 (control group, n=20); Underwent L4-5 right sided hemilaminotomy and annular fenestration (discectomy), and 0,9% saline was applied on the surgical area. In Group 2 (topical citicoline group, n=20); citicoline was applied to surgical area after identical surgical procedure. In Group 3 (systemic citicoline group, n=20); citicoline was applied intraperitoneally after identical surgical procedure. 4 rats was excluded due to death dependent on anesthetic complications or dural injury. All rats were decapitated after four weeks and their vertebral colons were removed en bloc. Groups were evaluated histopathological and results were compared with statistically.Compared with control group (group 1), significantly, less epidural fibrosis, dural adhesion, fibroblast cell density, foreign body reaction, and medulla spinalis retraction were observed in groups treated with local and systemic citicoline (groups 2 and 3) (p<0,001). There were no significant differences in any parameters between group 2 (topical citicoline group) and group 3 (systemic citicoline group) (p>0,05).Our study demonstrated that citicoline may be effective for preventing postoperative epidural fibrosis, however its effect should also be supported with clinical studies.
Description
Keywords
Epidural fibrozis, Laminotomi, Annular fenestrasyon, Lomber vertebra, Sitikolin, Epidural fibrosis, Laminotomy, Annular fenestration, Lumbar vertebra, Citicoline
Citation
Savran, M. (2010). Sıçanlarda epidural fibrozisin önlenmesinde, sitikolinin sistemik ve lokal etkinliğinin laminotomi / diskektomi modelinde araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.