The effect of adding carboxymethylcellulose and alginate to hyaluronic acid on reducing epidural fibrosis in a lumbar laminectomized rat model

OBJECTIVE: This study aimed to compare the anti-epidural fibrosis and anti-inflammation effects of hyaluronic acid (HA)-carboxy­methylcellulose (CMC)-alginate hydrogel, pure HA, and normal saline using a lumbar laminectomized rat model. METHODS: Thirty lumbar laminectomized adult rats were randomly assigned to three groups. The control group received normal saline, the HCA group received HA-CMC-alginate gel, and the HA group received pure HA gel soaked over the dura of the laminectomized area before closing the surgical wound. All rats were housed for eight weeks, then epidural fibrosis (EF) was histologically graded. In addition, the fibroblast and inflammatory cell density were computerized for evaluation. RESULTS: The mean fibroblast densities were 32.03 × 10(2) ± 488, 13.22 × 10(2) ± 200, and 14.52 × 10(2) ± 368 cell/mm(2) in the control, HCA, and HA groups, respectively. The mean inflammatory cell density was 30.74 × 10(2) ± 459, 5.90 × 10(2) ± 129, and 11.08 × 10(2) ± 282 cell/mm(2) in the control, HCA, and HA groups, respectively. The mean fibroblast and inflammatory cell densities in the HCA and HA groups were significantly lower than in the control group (P < 0.05). The HCA group had a significantly lower inflammatory cell density than the HA group (P < 0.05). The fibrous adherence grading of HCA and HA was significantly lower than the control (P < 0.05). CONCLUSION: HA-CMC-alginate gel and HA hydrogels seem to have a better preventative effect on EF than no treatment (control). HA-CMC-alginate can exhibit a better anti-inflammatory effect than HA. HA-CMC-alginate can be effective in reducing EF and inflammation after lumbar laminectomy.