The Prevention Effect of N-Acetylcysteine on Epidural Fibrosis in The Postlaminectomy Rat Model

Abstract

Aim: The development of epidural fibrosis after laminectomy lead to postoperative morbidities, persistent radicular pain and failed back syndrome. Various materials or drugs have been used to inhibit formation of epidural fibrosis and reduce the compressive effect on neural structures. Nevertheless, the effects are not satisfied. NAC has mucolytic, antioxidant and anti-inflammatory effect. The aim of this study was to evaluate the effect of NAC on spinal epidural fibrosis in the post-laminectomy rat model. Methods: Twenty-four albino rats were divided randomly into three equal groups: control, spongostan and Local NAC. Each animal underwent a laminectomy. Local NAC group (n=8): 100mg/kg was locally applied with a spongostan soaked with 0,5 ml of the solution and was left on the dura mater. At 4 weeks post surgery, the animals euthanized and their tissue samples at the laminectomy site were assessed histological evaluation for dura thickness, epidural fibrosis grading, inflammatory response grading and presence of arachnoidal involvement. All data were evaluated by statistically. Results: Epidural fibrosis were observed significant lower in the NAC group when compared with control group (p= 0.001) . Inflamattory cell density was significant lower in the NAC group when compared with control and spongostan group(p=0.001 and p=0.015, respectively). Arachnoidal involvement was not observed in NAC group. The differences between all groups weren’t statistically significant for dura thickness and fibloblastic density (p=0.162 and p=0.056, respectively, Kruskal Wallis test) Conclusion: The results of our study suggested that NAC has anti-fibrotic effects on epidural fibrosis in the post-laminectomy rat model.