Does vancomycin powder topically apply to the peripheral nerve cause perineural fibrosis?

Year 2021, Volume: 14 Issue: 2, 354 - 360, 01.04.2021

Semih Kivanc Olguner , Mustafa Çeliktaş , Kivilcim Erdogan , Kenan Dağlıoğlu , İsmail İştemen , Ali Arslan , Vedat Açık , Ali Ökten , Yurdal Gezercan

https://doi.org/10.31362/patd.789163

Abstract

Purpose:
The aim of this experimental rat study is to investigate whether vancomycin powder directly and topically applied on the sciatic nerve causes perineural fibrosis and chronic inflammation development.
Materials and Methods:
Thirty young adult male Wistar-Albino rats were included in the study and divided into 3 groups of 10 rats based on the dose to be applied after intraperitoneal anesthesia. After the sciatic nerve exploration, 10 rats (group 1) were administered a single dose of vancomycin powder, 10 rats (group 2) were administered a double dose of vancomycin, and control group was created with 10 animals which were administered no medication (group 3). After 3 weeks, rats were sacrificed, tissue samples were taken around sciatic nerve and sent for histopathological examination.
Results:
Grade 1 perineural fibrosis was detected in 1 animal (10%) in group 1. Grade 2 perineural fibrosis was detected in 1 animal (10%) and grade 1 perineural fibrosis was detected in 1 of 10 animals (10%) in group 2. In Group 3, grade 1 perineural fibrosis was detected in 1 experimental animal (10%). Chronic inflammation was not detected in any experimental animal. No significant difference was found between the 3 groups in terms of perineural fibrosis (p=0.753).
Conclusion:
In this experimental animal study, we found that fibrosis development did not differ significantly among the groups. We believe that more objective results can be obtained as a result of experimental studies with larger participation and more detailed histopathological examinations.

Keywords

perineural fibrosis;, sciatic nerve, vancomycin powder

Periferik sinir üzerinde topikal uygulanan vancomisin toz perinöral fibrozise neden olur mu?

Abstract

Amaç :
Bu deneysel sıçan çalışmasının amacı direk olarak siyatik sinir üzerine topikal uygulanan vancomisin tozun perinöral fibrozis ve kronik inflamasyon gelişimine neden olup olmadığını araştırmaktır.
Materyal-metod :
Otuz adet erkek Wistar-Albino cins sıçan çalışmaya dahil edilerek intraperitoneal anestezi sonrası uygulanacak doz miktarına göre 10’arlı 3 gruba ayrıldı. Siyatik sinir ekplorasyonu ardından tek doz vankomisin toz verilen 10 sıçan (grup 1), çift doz vankomisin uygulanan 10 sıçan (grup 2) , 10 hayvana ise ilaç verilmeyerek kontrol grubu (grup 3) oluşturuldu. 3 hafta sonra ise sıçanlar sakrifiye edilerek siyatik sinir etrafındaki doku örnekleri alındı ve histopatolojik incelemeye gönderildi.
Bulgular :
Grup 1 de 1 (%10) hayvanda evre 1 perinöral fibrosis tespit edildi. Diğer 9 (%90) deney hayvanında epidural fibrozis görülmedi. Grup 2 deki 10 deney hayvanından 1 tanesinde (%10) evre 2, 1 tanesinde ise (%10) evre 1 perinöral fibrozis saptandı. Sekiz hayvanda (%80) ise perinöral fibrozis bulgusu saptanmadı. Grup 3 de ise 1 (%10) deney hayvanında evre 1 perinöral fibrozis saptandı. Kronik inflamasyon ise hiçbir deney hayvanında tespit edilmedi. İstatistiksel incelemeler sonucunda 3 grup arasında perinöral fibrozis açısından anlamlı farklılık saptanmadı (p=0.753).
Sonuç :
Bu deneysel hayvan çalışmasında vankomisin toz uygulanan hastalarda fibrozis gelişiminin gruplar arasında anlamlı farklılık göstermediğini saptadık. Daha büyük katılımlı ve histopatolojik incelemelerin daha detaylı yapılacağı deneysel çalışmalar sonucunda daha objektif sonuçlara varılacağı kanaatindeyiz

Keywords

perinöral fibrozis, siyatik sinir, vankomisin toz

References

• 1. Fei Q, Li J, Lin J, et al. Risk Factors for Surgical Site Infection After Spinal Surgery: A Meta-Analysis. World Neurosurg. 2016;95:507-515. http://doi.org/10.1016/j.wneu.2015.05.059
• 2. Meredith DS, Kepler CK, Huang RC, Brause BD, Boachie-Adjei O. Postoperative infections of the lumbar spine: Presentation and management. Int Orthop. 2012;36(2):439-444. http://doi.org/10.1007/s00264-011-1427-z
• 3. Pull Ter Gunne AF, Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine (Phila Pa 1976). 2009;34(13):1422-1428. http://doi.org/10.1097/BRS.0b013e3181a03013
• 4. Bruniera FR, Ferreira FM, Saviolli LRM, et al. The use of vancomycin with its therapeutic and adverse effects: a review. Eur Rev Med Pharmacol Sci. 2015;19(4):694-700.
• 5. Clippinger B, Ayzenberg M, Narvaez M, et al. Effect of intrasite vancomycin powder on development of epidural fibrosis. Orthop Rev (Pavia). 2018;10(4):7777. http://doi.org/ 10.4081/or.2018.7777
• 6. Ghobrial GM, Cadotte DW, Williams K, Fehlings MG, Harrop JS. Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review. Neurosurg Focus. 2015;39(4):E11. http://doi.org/ 10.3171/2015.7.FOCUS15258
• 7. Texakalidis P, Lu VM, Yolcu Y, et al. Impact of Powdered Vancomycin on Preventing Surgical Site Infections in Neurosurgery: A Systematic Review and Meta-analysis. Neurosurgery. 2019;84(3):569-580. http://doi.org/ 10.1093/neuros/nyy288
• 8. Nahm F, Lee PB, Choe GY, Lim YJ, Kim YC. Therapeutic effect of epidural hyaluronic acid in a rat model of foraminal stenosis. J Pain Res. 2017;Volume 10:241-248. http://doi.org/ 10.2147/JPR.S122861
• 9. Chilukuri DM, Shah JC. Local delivery of vancomycin for the prophylaxis of prosthetic device-related infections. Pharm Res. 2005;22(4):563-572. http://doi.org/ 10.1007/s11095-005-2497-7
• 10. Godil SS, Parker SL, O’Neill KR, Devin CJ, McGirt MJ. Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma: clinical article. J Neurosurg Spine. 2013;19(3):331-335. http://doi.org/ 10.3171/2013.6.SPINE121105
• 11. Sweet FA, Roh M, Sliva C. Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: Efficacy, drug levels, and patient outcomes. Spine (Phila Pa 1976). 2011;36(24):2084-2088. http://doi.org/ 10.1097/BRS.0b013e3181ff2cb1
• 12. Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK. Lumbar laminectomy and fusion with routine local application of vancomycin powder: Decreased infection rate in instrumented and non-instrumented cases. Clin Neurol Neurosurg. 2013;115(9):1766-1769. http://doi.org/10.1016/j.clineuro.2013.04.005
• 13. Salafia CM, Weigl C, Silberman L. The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol. 1989;73(3 Pt 1):383-389.
• 14. Schroeder JE, Girardi FP, Sandhu H, Weinstein J, Cammisa FP, Sama A. The use of local vancomycin powder in degenerative spine surgery. Eur Spine J. 2016;25(4):1029-1033. http://doi.org/ 10.1007/s00586-015-4119-3
• 15. Heller A, McIff TE, Lai S-M, Burton DC. Intrawound Vancomycin Powder Decreases Staphylococcal Surgical Site Infections After Posterior Instrumented Spinal Arthrodesis. J Spinal Disord Tech. 2015;28(10):E584-E589. http://doi.org/ 10.1097/BSD.0000000000000045
• 16. Theologis AA, Demirkiran G, Callahan M, Pekmezci M, Ames C, Deviren V. Local intrawound vancomycin powder decreases the risk of surgical site infections in complex adult deformity reconstruction: A cost analysis. Spine (Phila Pa 1976). 2014;39(22):1875-1880. http://doi.org/10.1097/BRS.0000000000000533
• 17. Edin ML, Miclau T, Lester GE, Lindsey RW, Dahners LE. Effect of cefazolin and vancomycin on osteoblasts in vitro. Clin Orthop Relat Res. 1996;(333):245-251.
• 18. Emohare O, Ledonio CG, Hill BW, Davis RA, Polly DW, Kang MM. Cost savings analysis of intrawound vancomycin powder in posterior spinal surgery. Spine J. 2014;14(11):2710-2715. http://doi.org/ 10.1016/j.spinee.2014.03.011