Comparison of the effect of bipolar coagulation and fibrillar structured oxidized cellulose on formation epidural fibrosis in rats.

Abstract

BACKGROUND CONTEXT\nEpidural fibrosis (EF) is a common cause of failed back surgery syndrome seen after spinal surgeries. The most frequent reason for the formation of EF is accumulated blood and its products in the operation zone.\n\n\nPURPOSE\nOn the development of EF, the effect of bipolar coagulation and fibrillar oxidized cellulose, which are used frequently to control bleeding, was investigated. Stydy Design: In vivo animal study Methods: In the study, 45 male Sprague Dawley rats were divided into three groups (control, fibrillar, and bipolar). Lumbar laminectomy was applied to all rats under sterile conditions. In the control group, the epidural area was washed with saline solution. Bleeding was controlled with fibrillar oxidized cellulose in the fibrillar group, with bipolar coagulation in the bipolar group. The area to which laminectomy had been applied was removed as a block six weeks later and it was evaluated histopathologically and genetically in terms of EF development. Fibrosis degree was determined histopathologically by counting fibroblasts, using the modified Lubina and EF He grading systems. Interleukin-6 (IL-6), Transforming growth factor beta-1 (TGFß-1), and mRNA levels were measured by the droplet digital polymerase chain reaction method.\n\n\nRESULTS\nThe number of epidural fibroblasts, percentage of modified Lubina, amount of IL-6, and He grading rates were significantly lower in the fibrillar group than the bipolar and control groups (P?0.05). On the other hand, there was no significant difference among the control, fibrillar, and bipolar groups in terms of TGFß-1 values (P = 0.525).\n\n\nCONCLUSION\nThe use of fibrillar oxidized cellulose was more effective for hemostasis than bipolar coagulation in reducing the development of EF.