The effects of ankaferd blood stopper and microporous polysaccharide hemospheres on epidural fibrosis in rat laminectomy model 1. I MD, TC. Conception of the study; acquisition, interpretation and analysis of data; manuscript writing. Conception of the study; acquisition, interpretation and analysis of data; histophatological examinations; manuscript writing.
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The effects of ankaferd blood stopper and microporous polysaccharide hemospheres on epidural fibrosis in rat laminectomy model 1. I MD, TC. Conception of the study; acquisition, interpretation and analysis of data; manuscript writing. Conception of the study; acquisition, interpretation and analysis of data; histophatological examinations; manuscript writing.
Histophatological examinations. Conception of the study; acquisition, interpretation and analysis of data; manuscript writing; critical revision. To investigate whether topically administered hemostatic agents ankaferd blood stopper and microporous polysaccharide hemospheres can decrease epidural fibrosis after laminectomy in rats.
Eighteen adult male Sprague-Dawley rats were equally and randomly divided into three groups. In the treatment groups, ankaferd blood stopper and microporous polysaccharide hemospheres topically administrated upon duramater surface after laminectomy. Fibroblast count, epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. Our data revealed that the count of fibroblasts, the grading of epidural fibrosis and arachnoideal involvement in the rats treated with microporous polysaccharide hemospheres were significantly less than the control group.
Although the arachnoideal involvement in ankaferd blood stopper group were significantly less than the control group, there were no statistical differences when comparing the grading of epidural fibrosis and the fibroblasts count between the treatment groups and the control group. The ankaferd blood stopper and microporous polysaccharide hemospheres reduced epidural fibrosis and arachnoideal involvement after laminectomy in rats. Surgery for lumbar disc herniations are performed over than one million patients all over the world in every year 1 - 2.
The causes of failed back syndrome are diskectomy for wrong level, recurrent or persistent disc herniation, iatrogenic instability, central or lateral stenosis, arachnoiditis, and spinal epidural fibrosis 3 - 5. Epidural fibrosis cause nerve root traction, restricting of nerve root movements, extradural compression, and decreases the arterial supply of the nerve root.
Impaired axoplasmic transport and excretion of inflammatory mediators following the decreasing of arterial supply lead to intractable radicular pain 1 , 3 , 5 , 7. Both back and radicular pain associated with the EF are resistant to physical, medical and surgical treatments 1 - 8. Epidural fibrosis is also associated with an increased complication rate in revision spine surgery 9 , Epidural fibrosis is a part of the physiological tissue response after laminectomy.
Histologic studies have demonstrated that destruction of epidural fat, epidural hematoma accumulation and muscle invasion of the laminectomy site are the main responsible factors for the formation of dense EF. The destruction of epidural fat results that duramater is exposed to neighboring structures and create a cavity where blood refill as hematoma.
Regarding to hypothesis, the inadequate control of epidural bleeding during surgical interventions is strongly associated with epidural fibrosis 4 , 5 , The aim of this study is to investigate topically administered hemostatic agents, Ankaferd Blood Stopper ABS and Microporous Polysaccharide Hemospheres MPH can prevent epidural fibrosis and reduce arachnoideal involvement in a rat laminectomy model. The surgical procedures were performed under general anesthesia.
Rats were stabilized on the operation table in a prone position after deep anesthesia. The lower back of each rat, which is the surgical site, was sterilized with povidone. Following sterile isolation, long posterior midline surgical incisions were performed between the L4 and L6 levels.
The lumbar fascia was opened approximately Bilaterally, the paravertebral muscles were subperiostally dissected to expose the L laminae. A total L5 laminectomy and flavectomy were performed, and epidural fat tissues were removed, leaving the duramater clean and fully exposed.
The rats were then randomly allocated into three groups with six rats per group. After treatment, the wounds were primarily sutured in anatomical layers Prolen polypropylene sutures, Ethicon, Ethicon Endo-Surgery, Inc.
The rats had been then released for free food and water consumption for six weeks. The vertebral columns of the rats L were removed en bloc, including the whole laminectomy area, dural sacs, nerve roots, and paravertebral soft tissues.
Hemostasis had been achieved using cotton pad compression for several minutes. Any other hemostatic materials and bipolar cauterization were not applied.
The specimens were examined under a light microscope. Grading of EF and arachnoidal involvement was performed according to the definition of He et al.
The histological examination was conducted in a blinded manner by an experience examiner. To determine the number of fibroblasts taken from the three separate sections on each laminectomized spine, three distinct regions on the surface area were determined as Six different areas were counted on each animal, and stereological analyses of fibroblasts were conducted according to the studies described previously For each animal, the number of fibroblasts in the selected areas listed was adapted by one mm 2.
Whether the distributions of continuous variables were normally or not was determined by using Kolmogorov-Smirnov test. Chi-squared test was used for analysis of nominal categorical data. If p value less than 0. We did not observe any wound infection, abnormal foreign-body reaction, abscess formation, hematoma, or CSF leakages.
All animals were ambulatory at the time of sacrification. The count of fibroblast results were calculated as Photomicrographs demonstrating fibrosis in the control group. Direct contact between the underlying spinal cord SC and the epidural fibrosis tissue F is evident. Photomicrographs demonstrating fibrosis in the MPH group. No direct contact between the underlying spinal cord SC and the epidural fibrosis tissue F is evident.
Photomicrographs demonstrating fibrosis in the ABS group. The grading of EF was detected as 2. The gradings of arachnoidal involvement were detected as 2.
Stereological methods are commonly used in research of the fibroblast regarding to experimental peripheral nerve injuries model, and it was showed that the stereological analysis techniques can supply correct and trustworthy estimates of fibroblast count and epidural fibrosis 15 - Previous studies suggested that the fibroblast cells in the fibrous tissue should be counted in three different areas, expressed as a mean value, and the fibroblast densities should be graded In our study, to determine the number of fibroblasts, we performed a stereological morphometric analysis of the fibroblast densities for three separate sections and six different areas were counted on each animal.
To the best of our knowledge, this is the first report about the stereological analyses of fibroblasts for the evaluation of the EF after laminectomy in the literature. The first step for decreasing EF is achieving adequate hemostasis in surgical site.
Bipolar coagulation and cotton are broadly using for hemostasis. However, cotton and coagulation on the surgical site may cause additional fibrosis and adhesion formation 18 - Although both the introduction of microsurgical techniques and improvements in bipolar coagulation technology ease to hemostasis, EF after laminectomy can still occur 4 , 5 , To overcome this problem, several topical hemostatic agents were developed to prevent bleeding and achieve adequate hemostasis 6 , 20 - Hemostatic agents are more useful especially in the case of ooze bleeding with the risk of postoperative hematoma related to extensive EF.
Hemostatic agents using in neurosurgical interventions must have a strong hemostatic efficacy to provide durable hemostasis and also be degraded rapidly without tissue reaction or inflammation 3 , 21 , It is formed into tightly engineered microporous particles with porosity and spherical diameters and was recently approved by the Food and Drug Administration for internal use. Furthermore, it is shown that MPH reduces the incidence of surgical site infection It has been mostly used in surgeries on parenchymatous organs 23 , 24 , but there is no reports about the application of MPH after laminectomy for the prevention of EF.
This effect mostly related to its active hemostatic property. We can conclude that MPH can be applied safely for hemostasis in the case of ooze bleeding into the laminectomy site with the risk of postoperative EF. It is a standardized mixture of the agent containing various ratios of five herbal extracts: Thymus vulgaris, Glycyrrhiza Glabra, Vitis Vinifera, Alpinia Officinarum, and Urtica Dioica. Each herb has effects on the endothelium, blood cells, angiogenesis, cell proliferation, and other physiologic mediators 26 - It was shown that the ABS-induced network formation is related to the functions of blood proteins and red blood cells without destroying individual coagulation factors 26 - The basic mechanism of action for ABS is the formation of an encapsulated protein network that provides focal points for erythrocyte aggregation and forming a fibrin plug 27 , Previous studies have performed its safety, efficacy, sterility, and non-toxicity for external usage for hemostasis 26 - However, its effects on the formation of the fibrous tissue are still controversial.
Some studies suggest that the topical application of ABS increased pericardial adhesion and fibrosis In another experimental study, ABS application did not increase intra-abdominal adhesion formation Our study demonstrated that the topical application of ABS did not increase EF after laminectomy in a rat model.
Our results were similar with the previous studies which demonstrated the decreasing of adhesion formation after ABS application for hemostasis in the intra-abdominal surgeries This beneficial effect is mostly related to the hemostatic and anti-inflammatory activity of ABS.
The topical application of microporous polysaccharide hemospheres and ankaferd blood stopper significantly reduces EF formation, dural adhesion and fibroblast cell density in an experimental rat laminectomy model.
MPH and ABS, which have been previously used safely in humans for wound healing and parenchymatous organs hemostasis, "could be safely used for preventing epidural fibrosis after laminectomy in humans. Treatment of the failed back surgery syndrome due to lumbo-sacral epidural fibrosis. Acta Neurochir. PMID: Failed back surgery syndrome: 5-year follow-up in patients undergoing repeated operation.
Seven- to year outcome of lumbar discectomy. Spine Phila Pa Influence of TachoComb in comparison to local hemostyptic agents on epidural fibrosis in a rat laminectomy model.
Minim Invasive Neurosurg. Robertson JT. Role of peridural fibrosis in the failed back: a review. Eur Spine J. The role of closed-suction drainage in preventing epidural fibrosis and its correlation with a new grading system of epidural fibrosis on the basis of MRI. Revision surgery for failed back surgery syndrome.. Spine Phila Pa Aug;17 8
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Ankaferd BloodStopper
Blood ; 11 : The basic mechanism of action for ABS is the formation of an encapsulated protein network that provides focal points for vital erythrocyte aggregation. ABS—induced protein network formation with blood cells particularly erythrocytes covers the primary and secondary haemostatic system without disturbing individual coagulation factors Figure 1. The aim of this study is to perform functional proteomic analyses of ABS, which has been approved for the management of hemorrhages in Turkey www. The protein samples for 2D gel electrophoresis were prepared : 10 ml of Ankaferd solution was precipitated with Trichloroacetic Acid Precipitation TCA.
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Metrics details. Due to the detrimental effect of blood contamination on the physico-chemical properties of mineral trioxide aggregate MTA , obtaining an effective hemostasis in the surgical crypt during apical surgery is of paramount importance. The remaining 16 rats were designated as the control group. Rats in the experimental groups received freshly mixed MTA-Angelus in polyethylene tubes, which were inserted into monocortical bore holes created in their tibias. Slight inflammation in all groups was confined to day-7 only.
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Language: English French. To assess the hemostatic efficacy of the Ankaferd Blood Stopper ABS, Ankaferd Health Products Ltd, Turkey hemostatic agent for controlling gastrointestinal bleeding associated with various benign lesions refractory to conventional antihemorrhagic measures. The records of all patients who underwent upper and lower endoscopy procedures at the Turkiye Yuksek Ihtisas Teaching and Research Hospital Ankara, Turkey between April and June were reviewed. Patients in whom ABS was used as a primary or adjuvant hemostatic agent were included in the study. Rates of bleeding control and postprocedural complications were documented.
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Study record managers: refer to the Data Element Definitions if submitting registration or results information. The objective of this study was to prospectively compare effectiveness of Ankaferd Blood Stopper ABS with dry sponges in cessation of bleeding in adult trauma cases with external bleeding due to extremity lacerations. Methods: The study was conducted on patients with bleeding associated with extremity lacerations. All consecutive patients presented to the emergency department of the high-volume training hospital in Istanbul were recruited within the study period. This study was planned as a prospective randomized study. The longest duration for wound healing, infection follow-up, and suture removal was 12 days.