gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Rapamycin effectively prevents the formation of epidural fibrosis in a rat laminectomy model

Rapamycin verhindert die Ausbildung der epiduralen Fibrose im Laminektomie-Modell an der Ratte

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  • corresponding author C. Wetzel - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln
  • M. Löhr - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln
  • J. Y. Lee - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln
  • W. Stenzel - Institut für Neuropathologie, Klinikum der Universität zu Köln
  • N. Klug - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln
  • R.-I. Ernestus - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 056

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc325.shtml

Published: May 30, 2008

© 2008 Wetzel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Epidural fibrosis is one of the main reasons for the failed back surgery syndrome following lumbar disc operations and there is no satisfactory therapeutical approach so far. Rapamycin, a fungal-derived antibiotic, is used in transplantation medicine to prevent host-versus-graft reactions by its considerable antiproliferative capacity. The objective of the current study was to evaluate the effects of Rapamycin in the prevention of postoperative epidural fibrosis in a rat laminectomy model.

Methods: 10 Wistar rats received an epidural deposit of Rapamycin in a concentration of 100µg/ml after bisegmental laminectomy at noncontiguos sites. Control animals (n=10) were treated with an equal amount of saline. Twelve weeks later animals were perfused and laminectomy sites examined histologically for quantitative estimation of epidural fibrosis.

Results: Following saline administration, there was a widespread epidural fibrosis extending beyond the margins of the laminectomy site. The dura showed fibrotic thickening and was broadly adherent to the surrounding tissues. On the other hand, Rapamycin lead to a marked reduction of the epidural fibrosis with only loosely arranged areolar tissue found between the thecal sac and the solid scar covering the osseous borders of the laminectomy, thus maintaining the mobility of the thecal sac and nerve roots. The dura itsself exhibited no fibrotic changes. Interestingly, wound healing was unaffected by Rapamycin.

Conclusions: Rapamycin proved to effectively prevent epidural epidural fibrosis. In addition to other antiproliferative agents like Mitomycin C, the additional antiinflammatory features of Rapamycin may augment its impact on epidural scar formation by inhibition of and reduced systemic toxicity.