ABSTRACT
BACKGROUND CONTEXT
Excessive production of epidural fibrosis in the nerve root can be a pain source after
laminectomy. Pharmacotherapy is a minimally invasive treatment option to attenuate
epidural fibrosis by suppressing proliferation and activation of fibroblasts, inflammation,
and angiogenesis, and inducing apoptosis.
PURPOSE
We reviewed and tabulated pharmaceuticals with their respective signaling axes implicated
in reducing epidural fibrosis. Additionally, we summarized current literature for
the feasibility of novel biologics and microRNA to lessen epidural fibrosis.
STUDY DESIGN/SETTING
Systematic Review.
METHODS
According to the PRISMA guidelines, we systematically reviewed the literature in October
2022. The exclusion criteria included duplicates, nonrelevant articles, and insufficient
detail of drug mechanism.
RESULTS
We obtained a total of 2,499 articles from PubMed and Embase databases. After screening
the articles, 74 articles were finally selected for the systematic review and classified
based on the functions of drugs and microRNAs which included inhibition of fibroblast
proliferation and activation, pro-apoptosis, anti-inflammation, and antiangiogenesis.
In addition, we summarized various pathways to prevent epidural fibrosis.
CONCLUSION
This study allows a comprehensive review of pharmacotherapies to prevent epidural
fibrosis during laminectomy.
CLINICAL SIGNIFICANCE
We expect that our review would enable researchers and clinicians to better understand
the mechanism of anti-fibrosis drugs for the clinical application of epidural fibrosis
therapies.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: May 12, 2023
Accepted:
May 6,
2023
Received in revised form:
May 5,
2023
Received:
December 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable
Author disclosures: VG: Grants: NIH NIAMS (1R21AR080352-01) (Money paid directly to institution).
CI: Grants: NIH NIAMS (1R21AR080352-01) (Money paid directly to institution).
AP: Grants: NIH NIAMS (1R21AR080352-01) (Money paid directly to institution).
TL: Grants: NIH NIAMS (1R21AR080352-01) (Money paid directly to institution).
DS: Grants: NIH NIAMS (1R21AR080352-01) (Money paid directly to institution).
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