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Mitomycin protection of peridural fibrosis in lumbar disc surgery
Suat E Celik1, Tugrul Altan, Sevinç Celik
1Department of Neurosurgery, Beyoglu Eye Research and Training Hospital, Isrkey. suaterolcelik@yahoo.com
Object:
In this prospective, randomized clinical study the authors sought to evaluate the effects of locally applied mitomycin C on peridural fibrosis during lumbar microdiscectomy.
Methods:
Patients undergoing lumbar disc surgery were randomly divided into 2 groups. Thirty patients had 1 mg/ml mitomycin C applied at the site of discectomy for 5 minutes, and 30 age- and sex-matched patients underwent lumbar microdiscectomy without mitomycin C application as the control group. The groups were compared for degree of postoperative neurological function, radicular/back pain, and degree of peridural fibrosis on MR imaging 6 months after the operation.
Results:
The median follow-up was 18 months. No serious drug adverse effects and no clinically significant laboratory adverse effects were reported in patients in the mitomycin C group. Patients in both groups showed similar clinical recoveries postoperatively. On postoperative evaluation of the MR images, pain scores, and neurological function, patients given mitomycin C have shown no reduction of peridural fibrosis either clinically or radiographically.
Conclusions:
Mitomycin C is easy to use and safe in patients undergoing lumbar microdiscectomy. However, no benefit was observed either clinically or radiographically in this study.
Insights
Mitomycin C is a safe topical agent for lumbar microdiscectomy, but this study found it did not reduce peridural fibrosis or improve clinical outcomes compared to controls.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Clinical Pharmacology
Background:
- Peridural fibrosis is a common complication after lumbar microdiscectomy, potentially causing persistent radicular pain and neurological deficits.
- Mitomycin C (MMC) is an antifibrotic agent that has been investigated for its potential to reduce scar tissue formation in various surgical settings.
Purpose of the Study:
- To evaluate the efficacy and safety of locally applied mitomycin C in preventing peridural fibrosis following lumbar microdiscectomy.
- To assess the impact of mitomycin C on postoperative neurological function, pain, and radiographic evidence of fibrosis.
Main Methods:
- A prospective, randomized clinical trial involving 60 patients undergoing lumbar microdiscectomy.
- Patients were randomized into two groups: one receiving topical mitomycin C (1 mg/ml for 5 minutes) and a control group without mitomycin C.
- Outcomes were assessed at 6 months postoperatively, including neurological function, pain scores, and magnetic resonance imaging (MRI) for peridural fibrosis.
Main Results:
- No serious adverse effects related to mitomycin C were reported.
- Both the mitomycin C and control groups demonstrated similar clinical recovery and pain reduction.
- Postoperative MRI and clinical evaluations showed no significant difference in the degree of peridural fibrosis between the two groups.
Conclusions:
- Topical mitomycin C is safe and easy to administer during lumbar microdiscectomy.
- This study did not find any clinical or radiographic benefit of using mitomycin C to reduce peridural fibrosis after lumbar microdiscectomy.
