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Pharmacotherapies to Prevent Epidural Fibrosis after Laminectomy: A Systematic Review of In Vitro and In Vivo Animal Models
Journal article   Open access   Peer reviewed

Pharmacotherapies to Prevent Epidural Fibrosis after Laminectomy: A Systematic Review of In Vitro and In Vivo Animal Models

Venkateswaran Ganesh, Yochana Kancherla, Cassim M. Igram, Andrew J. Pugely, Aliasger K. Salem, Kyungsup Shin, Tae-Hong Lim and Dongrim Seol
The spine journal, Vol.23(10), pp.1471-1484
10/2023
DOI: 10.1016/j.spinee.2023.05.007
PMCID: PMC10538436
PMID: 37187251
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC10538436/pdf/nihms-1903417.pdfView
Open Access

Abstract

Excessive production of epidural fibrosis in the nerve root can be a pain source after laminectomy. Pharmacotherapy is a minimally invasive treatment option to attenuate epidural fibrosis by suppressing proliferation and activation of fibroblasts, inflammation, and angiogenesis, and inducing apoptosis. We reviewed and tabulated pharmaceuticals with their respective signaling axes implicated in reducing epidural fibrosis. Additionally, we summarized current literature for the feasibility of novel biologics and microRNA to lessen epidural fibrosis. Systematic Review According to the PRISMA guidelines, we systematically reviewed the literature in October 2022. The exclusion criteria included duplicates, non-relevant articles, and insufficient detail of drug mechanism. We obtained a total of 2,499 articles from PubMed and Embase databases. After screening the articles, 74 articles were finally selected for the systematic review and classified based on the functions of drugs and microRNAs which included inhibition of fibroblast proliferation and activation, pro-apoptosis, anti-inflammation, and anti-angiogenesis. In addition, we summarized various pathways to prevent epidural fibrosis. This study allows a comprehensive review of pharmacotherapies to prevent epidural fibrosis during laminectomy. We expect that our review would enable researchers and clinicians to better understand the mechanism of anti-fibrosis drugs for the clinical application of epidural fibrosis therapies. [Display omitted]
Pharmacotherapy Epidural fibrosis Failed back surgery syndrome Laminectomy MicroRNA Peridural fibrosis

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