Is topical tissue plasminogen activator application effective on prevention of post-laminectomy epidural fibrosis? An experimental study

Abstract

Objective: Impaired fibrinolytic activity has been shown to be associated with poor outcome after lumbar disc surgery. The purpose of this study was to determine the efficacy of topical tissue plasminogen activator (t-PA) in preventing epidural fibrosis in rats.

Methods: L4–L5 laminectomy was performed under surgical microscope in 40 rats. Animals received either normal saline (control; n=20) or 0.5 mg/kg t-PA (n=20), topically to the operative sites. All animals were killed 1, 2, 4 and 6 weeks after surgery. Fibrosis, inflammation, necrosis and abscess formation were evaluated histopathologically.

Results: The results showed that 6 weeks after surgery, inhibition in formation of epidural fibrosis was noted in both control and treatment animals. We found no significant differences in inflammation, tissue necrosis and abscess formation between groups.

Conclusion: A meticulous microsurgical technique with careful hemostasis seems to be an effective and adequate method for prevention of epidural fibrosis.

Keywords:

• EPIDURAL FIBROSIS
• POST-LAMINECTOMY
• TISSUE PLASMINOGEN ACTIVATOR