Abstract
Postsurgical adhesions are a common problem in clinical practice, causing nerve compression, pain and discomfort. A new hydrogel based on gellan gum and sulphated hyaluronic acid was synthesized, with the aim to create an effective barrier for epidural scar formation. Physico-chemical properties of the gel were analyzed, and preliminary biocompatibility data (i.e. cytotoxicity) have been collected in view of its potential clinical use. The characterization of the new material demonstrated that the hydrogel, due to its high-viscosity, could effectively act as a barrier with a long in situ residence time. In addition, the hydrogel can be easily extruded from a syringe and its structure exhibits excellent stabilizing properties. Furthermore, biological assays showed that this gel is suitable for further preclinical development.
Similar content being viewed by others
References
La Rocca H, Macnab I. The laminectomy membrane: studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg (Br). 1974;56B:545–50.
Frederickson RC. ADCON-L: a review of its development, mechanism of action, and preclinical data. Eur Spine J. 1996;5(suppl 1):7–9.
Snow DM, Lemmon V, Carrino DA, Caplan AI, Silver J. Sulfated proteoglycans in astroglial barriers inhibit neurite outgrowth in vitro. Exp Neurol. 1990;109:111–30.
Einhaus SL, Robertson JT. Reduction of peridural fibrosis after lumbar laminotomy and discectomy in dogs by a resorbable gel (ADCON-L). Spine. 1997;22:1440–7.
de Tribolet N, Porchet F, Lutz TW, Gratzl O, Brotchi J, van Alphen HA, van Acker RE, Ross JS. Clinical assessment of a novel antiadhesion barrier gel: prospective, randomized, multicenter, clinical trial of ADCON-L to inhibit postoperative peridural fibrosis and related symptoms after lumbar discectomy. Am J Orthop. 1998;27:111–20.
Kiviluoto O. Use of free fat transplants to prevent epidural scar formation. An experimental study. Acta Orthop Scand Suppl. 1976;164:1–75.
Langenskiold A, Kiviluoto O. Prevention of epidural scar formation after operations on the lumbar spine by means of free fat transplants. A preliminary report. Clin Orthop Relat Res. 1976; 115:92–5.
Barberà J, Gonzalez J, Esquerdo J, Broseta J, Barcia-Salorio JL. Prophylaxis of the laminectomy membrane. An experimental study in dogs. J Neurosurg. 1978;49:419–24.
Keller JT, Dunsker SB, McWhorter JM, Ongkiko CM, Saunders MC, Mayfield FH. The fate of autogenous grafts to the spinal dura. An experimental study. J Neurosurg. 1978;49:412–8.
Jacobs RR, McClain O, Neff J. Control of postlaminectomy scar formation: an experimental and clinical study. Spine. 1980;5:223–9.
Lee CK, Alexander H. Prevention of postlaminectomy scar formation. Spine. 1984;9:305–12.
Boot DA, Hughes SP. The prevention of adhesions after laminectomy. Adverse results of Zenoderm implantations into laminectomy sites in rabbits. Clin Orthop Relat Res. 1987;215:296–302.
Foulkes GD, Robinson JS. Intraoperative dexamethasone irrigation in lumbar microdiskectomy. Clin Orthop Relat Res. 1990;261:224–8.
Lawson KJ, Malycky JL, Berry JL, Steffee AD. Lamina repair and replacement to control laminectomy membrane formation in dogs. Spine. 1991;16(suppl 6):222–6.
Robertson JT, Soble-Smith J, Powers N, Nelson PA. Prevention of cerebrospinal fistulae and reduction of epidural scar with new surgical hemostat device in a porcine laminectomy model. Spine. 2003;28:2298–303.
Fransen P. Safety of carboxymethylcellulose/polyethylene oxide for the prevention of adhesions in lumbar disc herniation—consecutive case series review. Ann Surg Innov Res. 2008;2:2–5.
Mayfield FH. Autologous fat transplants for the protection and repair of the spinal dura. Clin Neurosurg. 1980;27:349–61.
Bryant MS, Bremer AM, Nguyen TQ. Autogeneic fat transplants in the epidural space in routine lumbar spine surgery. Neurosurgery. 1983;13:367–70.
Dubin LM, Quencer AM, Green BA. A mimicker of a postoperative spinal mass: gelfoam in a laminectomy site. AJNR. 1988;9:217–8.
Le AX, Rogers DE, Dawson EG, Kropf MA, De Grange DA, Delamarter RB. Unrecognized durotomy after lumbar discectomy: a report of four cases associated with the use of ADCON-L. Spine. 2001;26:115–7.
Hieb LD, Stevens DL. Spontaneous postoperative cerebrospinal fluid leaks following application of anti-adhesion barrier gel: case report and review of the literature. Spine. 2001;26:748–51.
Songer MN, Ghosh L, Spencer DL. Effects of sodium hyaluronate on peridural fibrosis after lumbar laminotomy and discectomy. Spine. 1990;15:550–4.
Massie JB, Schimizzi AL, Huang B, Kim CW, Garfin SR, Akeson WH. Topical high molecular weight hyaluronan reduces radicular pain post laminectomy in a rat model. Spine J. 2005;5:494–502.
Magnani A, Lamponi S, Rappuoli R, Barbucci R. Sulphated hyaluronic acids: a chemical and biological characterization. Polymer Int. 1998;46:225–40.
Crescenzi V, Francescangeli A, Renier D, Bellini D. New cross-linked and sulfated derivatives of partially deacetylated hyaluronan: synthesis and preliminary characterization. Biopolymers. 2002;64:86–94.
Chang NS, Intrieri C, Mattison J, Armand G. Synthetic polysulfated hyaluronic acid is a potent inhibitor for tumor necrosis factor production. J Leukoc Biol. 1994;55:778–84.
Miyoshi E, Takaya T, Nishinari K. Rheological and thermal studies of gel-sol transition in gellan gum aqueous solutions. Carbohydr Polym. 1996;30:109–19.
Carlfors J, Edsman K, Petersson R, Jörnving K. Rheological evaluation of Gelrite in situ gels for ophthalmic use. Eur J Pharm Sci. 1998;6:113–9.
Miyazaki S, Aoyama H, Kawasaki N, Kubo W, Attwood D. In situ-gelling gellan formulations as vehicles for oral drug delivery. J Control Release. 1999;60:287–95.
Bellini D, Longinotti C, Crescenzi V, Taglienti A. Biomaterials consisting of sulphated hyaluronic acid and gellan to be used in the prevention of spinal adhesions. Fidia Advanced Biopolymers s.r.l. Patent Number WO2006037592: 13-04-2006.
Casu B, Gennaro U. A conductimetric method for the determination of sulphate and carboxyl groups in heparin and other mucopolysaccharides. Carbohydr Res. 1975;39:168–76.
NF EN ISO 10993 “Biological evaluation of medical devices”, 2004.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cencetti, C., Bellini, D., Longinotti, C. et al. Preparation and characterization of a new gellan gum and sulphated hyaluronic acid hydrogel designed for epidural scar prevention. J Mater Sci: Mater Med 22, 263–271 (2011). https://doi.org/10.1007/s10856-010-4217-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10856-010-4217-z