Abstract

BackgroundEpidural fibrosis is one of the aetiologies of pain following a spinal revision surgery. It is reported that the specific members of the mitogen – activated protein kinases (MAPK) family might mediate neuropathic pain. However, roles of epidural fibrosis caused by repeated spinal surgeries and pain-related proteins in causing the post spinal surgery syndrome remain unknown. Using a rat spinal surgery epidural fibrosis and adhesion model, in this study, we evaluated and investigated the relationship between pain markers and epidural fibrosis.MethodsSprague–Dawley rats that underwent the spinal surgery were divided into three groups: group A (single laminectomy), group B (two repeated surgeries) and group C (three repeated surgeries). Dural thickness was measured in each experimental group, and immunohistochemical analysis and western blotting of mitogen-activated protein kinases were performed (ERK, p38 and JNK) using the spine cord.ResultsDural thickness was 6.363 ± 1.911 μm in group A, 13.238 ± 2.123 μm in group B and 19.4 ± 2.115 μm in group C, respectively. In the western blotting, phosphorylated ERK expression gradually increased with the number of repeated surgeries, and expression in groups B (1.77-fold) and C (2.42-fold) increased as compared to expression in group A. Phosphorylated p38 showed an increasing trend with the number of repeated surgeries, and groups B (1.17-fold) and C (1.33-fold) expression increased compared with group A. However, phosphorylated JNK expression did not gradually increase with the number of repeated surgeries, and groups B (1.62-fold) and C (1.43-fold) expression increased compared with group A. Excluding phosphorylated JNK, immunohistochemical analysis revealed that phosphorylated ERK and p38 expression gradually increased with the number of repeated surgeries in the spine dorsal horn, as evidenced by western blotting.ConclusionsRepeated spinal surgeries may increase dural thickness and expression of phosphorylated ERK and p38 in the spinal dorsal horn, and it suggests that the neuropathic pain is likely induced by epidural fibrosis and that the pain increases with the number of repeated surgeries.

Highlights

  • Epidural fibrosis is one of the aetiologies of pain following a spinal revision surgery

  • We evaluated the extent of epidural fibrosis by measuring dural thickness and investigated the association of mitogen-activated protein kinases (MAPKs) expression in the spinal dorsal horn to study the relationship between epidural fibrosis and pain markers

  • Epidural fibrosis following repeated laminectomy Epidural fibrosis was indirectly analysed by measuring the dural thickness

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Summary

Introduction

Epidural fibrosis is one of the aetiologies of pain following a spinal revision surgery. It is well accepted that epidural fibrosis causes pulling, stretching or compression of the associated nerve root or dura mater and can lead to persistent back and leg pain following lumbar laminectomy, known as the post laminectomy syndrome, failed back surgery syndrome (FBSS) or post spinal surgery syndrome [6, 7]. Revision surgery in these cases has greater complication rates along with decreased success rate to 30% after the second, 15% after the third, and 5% after the fourth surgery [8]. It is difficult to expect good outcomes even when repeated surgeries are required to be performed to eliminate epidural fibrosis and adhesions

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