Prevention of epidural scar adhesion after lumbar surgery by the use of medical cross-linked high-molecular-weight sodium hyaluronate gel

Abstract

Objective To evaluate the preventive effect of medical cross-linked high-molecular-weight sodium hyaluronate gel for epidural scar adhesion after lumbar surgery. Methods Atotal of 92 patients were divided into 2 groups. Fifty-two patients in group A underwent decompression surgery combined with medical sodium hyaluronate gel. Forty patients in group B underwent only decompression surgery. The patients were given posterolateral fixation with pedicle screw and decompression, interbody fusion through posterior lumbar interbody fusion (TLIF) with or without the use of medical sodium hyaluronate gel. Operating time, blood loss and volume of drainage after operation were compared between two groups. Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) in lower extremity pain were applied to evaluate the therapeutic effect. The radius vector of sagittal spinal canal and the thecal sac cross sectional area were measured by magnetic resonance imaging (MRI). Results All patients underwent surgery safely without severe complications occurred. There was no significant difference in general materials and operation time (t=1.736, P=0.086), blood during operation (t=1.084, P=0.281), volume of drainage after operation (t=0.816, P=0.417) between two groups. As compared with preoperative parameters, the scores of VAS in back pain and lower limb pain and ODI were decreased significantly after surgery and at the final follow-up in both two groups. There was significant difference in lower limb VAS score between two groups, but there was no significant difference between two groups in ODI scores and back pain VAS score. There was no significant difference between Group A [(15.52±0.98) mm] and B [(15.13±1.07) mm] in L4/5 sagittal spinal canal after surgery (t=1.841, P=0.069). There was significant difference between Group A [(181.58±8.19) mm2] and B [(169.03±6.02) mm2] in the thecal sac cross sectional area (t=0.814, P=0.000). Conclusion Lumbar decompression surgery combined with medical sodium hyaluronate gel had a beter effect than simple operation. It can provide better prevention for epidural adhesions and more satisfactory clinical effects. Key words: Lumbar degeneration disease; Surgery; Medical sodium hyaluronate gel; Epidural adhesion; Prevention