Use of carboxymethylcellulose/polyethylene oxide gel in microdiscectomy with interlaminectomy: a case series comparison with long-term follow-up

Spine (Phila Pa 1976). 2008 Jul 15;33(16):1762-5. doi: 10.1097/BRS.0b013e31817e30fb.


Study design: A consecutive, case series comparison.

Objective: To compare safety, long-term pain, and disability scores with and without use of carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel after microdiscectomy with interlaminectomy.

Summary of background data: Patient outcomes after microdiscectomy for lumbar disc herniation are frequently complicated by adhesions and fibrotic scars. Present management is controlled by good surgical technique as adhesion-reduction agents to date, have either proved ineffective or toxic. In 2002 a 100% synthetic combination of CMC/PEO, which reduces adhesions and fibrosis, became available across Europe as a gel application, (OXIPLEX/SP adhesion barrier gel FzioMed, Inc., San Luis Obispo, CA) and distributed under the trade names OXIPLEX/SP adhesion barrier gel (DePuy International, Ltd., Leeds, United Kingdom) and MEDISHIELD adhesion barrier gel (Medtronic International Trading SARL, Tolochenaz, Switzerland).

Methods: A consecutive series of 70 patients with lumbar disc herniation undergoing microdiscectomy with interlaminectomy by the same surgeon were treated at the end of surgery with either CMC/PEO gel (N = 35) or no gel (N = 35). Treatments were allocated by an independent investigator. At presurgery and regular intervals over 3 years postsurgery, Oswestry disability index (ODI) and leg and back pain scores determined by visual analog scales (VAS), were assessed by a member of the surgical team blinded to the initial treatment allocation.

Results: Three years postsurgery reduction in disability as measured by the decrease in ODI compared with presurgery (mean +/- SD) was significantly (P < 0.05) greater with CMC/PEO than controls (-49.4 +/- 12.7 vs. -41 +/- 17.8). CMC/PEO treatment also resulted in significantly more patients having no disability as measured by reaching 0% ODI scores (15 CMC/PEO [43%] vs. 0 control group [0%]) (P < 0.01). Leg and back pain as measured by the decrease in VAS scores 3 years postsurgery were reduced with CMC/PEO compared with controls(leg -6.8 +/- 1.7 vs. -5.6 +/- 1.6, back -0.4 +/- 1.5 vs. -0.1 +/- 2.0), P < 0.05 for leg pain. Importantly there were no safety issues and no differences in complications between the 2 treatment groups during the 30 day postoperative period.

Conclusion: CMC/PEO gel after microdiscectomy with interlaminectomy appears safe to use and in a 3-year follow-up significantly reduces disability and leg pain scores compared with our conventional treatment.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carboxymethylcellulose Sodium / administration & dosage*
  • Disability Evaluation
  • Diskectomy / methods*
  • Female
  • Follow-Up Studies
  • Gels
  • Humans
  • Intervertebral Disc Displacement / drug therapy
  • Intervertebral Disc Displacement / pathology
  • Intervertebral Disc Displacement / surgery
  • Laminectomy / methods*
  • Lumbar Vertebrae / drug effects
  • Lumbar Vertebrae / pathology
  • Lumbar Vertebrae / surgery*
  • Male
  • Microsurgery / methods
  • Middle Aged
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / prevention & control
  • Polyethylene Glycols / administration & dosage*
  • Research Design
  • Time


  • Gels
  • Polyethylene Glycols
  • Carboxymethylcellulose Sodium