Sıçan Laminektomi Modelinde Halofuginonun Epidural Fibrozis Üzerine Etkisinin İncelenmesi

Abstract

Low back pain is an important health problem encountered by 80% of the society at least once in their life, constituting an important part of hospital admissions, reducing the quality of life and causing loss of workforce. Lumbar disc herniation, which is the most common cause of low back pain, requires medical and/or surgical treatment. Epidural fibrosis is the most common cause of unsuccessful back surgery syndrome, in which complaints such as low back and leg pain continues after spinal surgery. It causes scar tissue around the neural tissue and compresses it and causes radicular pain by disrupting the nutrition of the nerve roots. Today, although many studies have been conducted to prevent or reduce epidural fibrosis, no definitive solution has been found. Halofuginone is an analogue of the alkaloid februfigin obtained from the plant Dichroa febrifuga. This drug, which is used by veterinarians as an antiprotozoan, has been shown to inhibit type 1 collagen synthesis and have an antifibrotic effect when administered orally and/or systemically in in vivo and in vitro studies. In this study, it was aimed to investigate the antifibrotic effect of locally applied Halofuginone in the lumbar laminectomy model created in rats. In the study, a total of 21 rats were used in 3 separate groups and 7 Wistar Albino male rats (n=7) in each group. Seven of them were divided into the control group that underwent laminectomy, 7 of them were divided into the group in which hydrogel was placed in the laminectomy area, and 7 of them were divided into the group in which Halofuginone-loaded hydrogel was placed in the laminectomy area. Tissues including spinal column, vertebral column, paravertebral muscles and fascia were taken from rats sacrified on the post-operative 21st day, 1 cm above and below the laminectomy site. They were washed with saline, kept in formaldehyde solution for a week, and after decalcification, they were dehydrated and taken into paraffin blocks. After the serial sections were obtained, the area of epidural fibrosis and the degree of adhesion of the fibrosis were analyzed by staining with hematoxylin-eosin (HE) and Masson's trichrome stain. The prominent points in the results of the study are that there are intense fibrosis and active fibroblasts in the control group, a membranous structure that can prevent fibrosis formation by forming a mechanical barrier in the hydrogel group, and the low distribution of fibrous tissue in the hydrogel and Halofuginone groups, as well as the enlargement of the vascular structures in some regions. active osteoblasts were present. In addition, there was no infiltrative inflammatory cell, no foreign body reaction, and no new bone formation that could fill the laminectomy area was observed in all three groups. When the epidural fibrosis area in square millimeters was evaluated statistically in all three groups, it was determined that there was no significant difference. In terms of the degree of fibrosis adhesion, it was found statistically significant between the control group and the hydrogel + Halofuginone groups.