Chitosan Dextran gel as an anti adhesion agent in a postlaminectomy spinal sheep model

J Clin Neurosci. 2017 Jun;40:153-156. doi: 10.1016/j.jocn.2017.02.010. Epub 2017 Mar 11.

Abstract

Introduction: Post-operative peridural adhesions increase morbidity after neurosurgical procedures. Aim of this study is to assess safety and efficacy of Chitosan-Dextran (CD) gel as an anti-adhesion agent in a spinal laminectomy sheep model.

Methods: Eighteen sheep were used in this study with 6 animals in each treatment arm (namely, CD gel, Gelfoam paste and normal saline control). Posterior lumbar laminectomy was performed in all animals and the dura was exposed intact. Test agents were applied over the exposed dura and the wound was closed in layers. Sheep were euthanized at the end of three months. MRI spine was performed after euthanasia to assess epidural fibrosis. Adhesion in the spinal specimen was assessed by Peel test and histopathology was used to assess safety of the agents.

Results: Average scores for the Peel test for CD gel, Gelfoam and normal saline control groups were 1.16 (95% CI, 0.5-1.7), 1.5 (95% CI, 0.6-2.3) and 3 (95% CI, 2.1-3.8) respectively. There was significant reduction in adhesions between treatment and normal saline treated groups (p=0.0292), with no difference between Gelfoam and CD gel groups (p=0.56). Average scores on MRI for CD gel, Gelfoam and normal saline groups were 1.4 (95% CI, 0.9-1.8), 1.5 (95% CI, 1.2-1.8) and 1.6 (95% CI, 1.3-1.8) respectively, with no significant difference in fibrosis amongst (p=0.2992). Histopathology did not show any adverse effects.

Conclusion: CD gel is an effective agent to reduce epidural adhesions with a good safety profile in neural tissue.

Keywords: Adhesions; Chitosan; Gelfoam; Laminectomy; Sheep; Spine.

MeSH terms

  • Animals
  • Chitosan / analogs & derivatives*
  • Chitosan / therapeutic use
  • Dextrans / chemistry
  • Gelatin Sponge, Absorbable / adverse effects
  • Gelatin Sponge, Absorbable / chemistry
  • Gelatin Sponge, Absorbable / therapeutic use*
  • Hemostatic Techniques
  • Laminectomy / methods*
  • Postoperative Complications / prevention & control*
  • Postoperative Complications / therapy
  • Sheep
  • Spinal Cord / pathology
  • Spinal Cord / surgery*
  • Tissue Adhesions

Substances

  • Dextrans
  • Chitosan