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        Chitosan Pad, Cellulose Membrane, or Gelatin Sponge for Peridural Bleeding: An Efficacy Study on a Lumbar Laminectomized Rat Model

        Surachai Sae-Jung,Punyawat Apiwatanakul 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

        Study Design: Experimental study in an animal model. Purpose: This study aims to evaluate the hemostatic properties of four common hemostatic materials including the chitosan clot pad, absorbable gelatin sponge, cellulose membrane, and gauze on peridural bleeding using a rat model. Overview of Literature: Intraoperative bleeding during spinal surgery can lead to morbidities. Hemostatic materials have been developed, but the efficacy of these materials on peridural bleeding remains unclear. Methods: Forty 8-week-old Sprague-Dawley rats were used in this study. Under adequate anesthesia, each rat was posteriorly dissected to their L5 and L6 spinous processes. Bleeding from muscles and soft tissue dissections was stopped before lumbar bone cutting. Immediately after the L5–L6 laminae were cut and removed, the rats were randomly allocated to receive one of the abovementioned hemostatic materials. All hemostatic materials were placed over the raw surface of cut bone and dura and changed every 60 seconds. The procedure was stopped when there was no further bleeding. Time to staunching and amount of bleeding were recorded for statistical analysis. Results: The respective mean±standard deviation hemorrhage volume and time for the cellulose membrane, gelatin sponge, chitosan pad, and gauze were 1.19±0.44, 1.03±0.72, 0.96±0.57, and 1.98±0.62 mL, respectively, and 2.9±0.6, 2.1±0.6, 1.7±0.5, and 2.9±1.0 minutes, respectively. The overall bleeding volumes for the cellulose membrane, gelatin sponge, and chitosan pad were significantly lower than the overall bleeding volume for gauze. Conclusions: Chitosan clot pads, gelatin sponges, and cellulose membranes have better hemostatic properties than gauze. The chitosan pad had the lowest average bleeding volume, followed by gelatin sponge and cellulose membrane.

      • KCI등재

        Interrater Reliability of the Postoperative Epidural Fibrosis Classification: A Histopathologic Study in the Rat Model

        Surachai Sae-Jung,Kitti Jirarattanaphochai,Chat Sumananont,Kriangkrai Wittayapairoj,Kamolsak Sukhonthamarn 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.4

        Study Design: Agreement study. Purpose: To validate the interrater reliability of the histopathological classification of the post-laminectomy epidural fibrosis in an animal model. Overview of Literature: Epidural fibrosis is a common cause of failed back surgery syndrome. Many animal experiments have been developed to investigate the prevention of epidural fibrosis. One of the common outcome measurements is the epidural fibrous adherence grading, but the classification has not yet been validated. Methods: Five identical sets of histopathological digital files of L5–L6 laminectomized adult Sprague-Dawley rats, representing various degrees of postoperative epidural fibrous adherence were randomized and evaluated by five independent assessors masked to the study processes. Epidural fibrosis was rated as grade 0 (no fibrosis), grade 1 (thin fibrous band), grade 2 (continuous fibrous adherence for less than two-thirds of the laminectomy area), or grade 3 (large fibrotic tissue for more than two-thirds of the laminectomy area). A statistical analysis was performed. Results: Four hundred slides were independently evaluated by each assessor. The percent agreement and intraclass correlation coefficient (ICC) between each pair of assessors varied from 73.5% to 81.3% and from 0.81 to 0.86, respectively. The overall ICC was 0.83 (95% confidence interval, 0.81–0.86). Conclusions: The postoperative epidural fibrosis classification showed almost perfect agreement among the assessors. This classification can be used in research involving the histopathology of postoperative epidural fibrosis; for example, for the development of preventions of postoperative epidural fibrosis or treatment in an animal model.

      • Anatomical Variation and Morphometric Study on Foramen Transversarium of the Upper Cervical Vertebrae in the Thai Population

        Chaiyamoon Arada,Yannasithinon Supataechasit,Sae-Jung Surachai,Samrid Rarinthorn,Thongbuakaew Tipsuda,Iamsaard Sitthichai 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.5

        Study Design: Foramen transversarium (FT) and foramen arcuale (FA) of upper cervical vertebrae (C1 and C2) in the Thai population were investigated for variation and morphometry. Purpose: This study aimed to reveal the morphometry of FT and FA in the Thai population. Overview of Literature: The FT and FA are structures found in the upper spine that support the vertebral neurovascular system. Clinically, the surgical approaches to achieve upper cervical stability can be affected by spine variations. FT and FA morphometries have been documented to vary by nationality. However, such reports have been limited in the Thai population. Methods: The FT and FA of dried C1 and C2 vertebrae (identified bones; n=107, males=53 and females=54) were observed and measured using a Digital Vernier Caliper (Mitutoyo, Kawasaki, Japan). Anteroposterior (AP) and transverse diameters of the left and right FTs (n=214) were measured and compared between sexes. Variations and types of FT and FA found on the upper vertebrae were recorded and classified. Results: The FT shape of the Thai C1 was AP elliptical, while of that of C2 was transverse elliptical. Compared to females, both diameters of the upper spine were significantly greater in males except for the AP diameter of C2 on the right side. All diameters were significantly different in both sexes and sides except for the AP diameter of C1 and C2. A common type of FT classified in C1 was type 2 (male [69.81%], female [79.63%]) whereas for C2 it was type 1 (male [63.21%], female [59.26%]). Moreover, an incomplete osseous bridge was a major FA subtype observed in the Thai spine. Conclusions: FT morphometry has an elliptical shape and diameters are greater in males. The FT and FA variations identified in this study will be useful for surgeons treating vertebral neurovascular injuries of the posterior upper cervical spine in the Thai population.

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