Safety of carboxymethylcellulose/polyethylene oxide for the prevention of adhesions in lumbar disc herniation – consecutive case series review

To determine the safety and assess efficacy of carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel as an anti-adhesion gel, a consecutive series of 396 patients undergoing lumbar discectomy performed by one surgeon had CMC/PEO gel administered at the end of surgery. The patients were followed up in accordance with standard clinical practice and records reviewed for side effects, such as skin reactions, general reactions or local fluid collections. Reoperations for recurrent herniation included an evaluation of fibrosis reduction.No product related complications were observed. Five patients needed reoperations for recurrent herniation. Significant but subjective reduction in fibrosis was observed in these patients.The findings provide confidence that CMC/PEO gel is well tolerated as an agent to achieve reduction of fibrosis in lumbar disc surgery. Further formal prospective study is recommended in this area of unmet need.Although normal healing involves the migration of fibroblasts to a wound site to form a matrix of scar tissue, excessive scar tissue may cause impairment in function, either by direct compression or by tethering of nervous tissues to the surrounding muscle or bone. Such epidural fibrosis is estimated as contributing to 60% of all cases of recurring back pain symptoms in the heterogeneous condition known as failed back surgery syndrome (FBSS) which occurs after discectomy or laminectomy [1]. The direct costs of further diagnostic measures, treatments and repeat surgery, as well as additional societal costs, emphasize the importance of preventive measures during surgery. While spinal surgeons have responded to this challenge by improvements in surgical technique, the problem remains and use of an interposition agent to reduce scarring after discectomy is recognized in the recent Cochrane review as likely to be an important strategy [2].Recently several types of bioresorbable gels applied directly to the organs and acting as a chemical or physical b