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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(03): 478-483
DOI: 10.1055/s-0044-1787777
Original Article

Usefulness and Safety of Gelatin–Thrombin Matrix Sealants in Minimally Invasive Microscopic Discectomy

Yushi Sakamoto
1   Department of Spine Surgery, Naruo Orthopedic Hospital, Kumamoto, Japan
2   Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
,
Seiichiro Naruo
1   Department of Spine Surgery, Naruo Orthopedic Hospital, Kumamoto, Japan
,
Tomonori Ozaki
1   Department of Spine Surgery, Naruo Orthopedic Hospital, Kumamoto, Japan
,
Shogo Tahata
1   Department of Spine Surgery, Naruo Orthopedic Hospital, Kumamoto, Japan
,
Toru Fujimoto
1   Department of Spine Surgery, Naruo Orthopedic Hospital, Kumamoto, Japan
,
Atushi Ogata
2   Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
,
Fumitaka Yoshioka
2   Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
,
Yukiko Nakahara
2   Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
,
Jun Masuoka
2   Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
,
Tatsuya Abe
2   Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to evaluate the usefulness and safety of gelatin–thrombin matrix sealants (GTMSs) in minimally invasive microscopic discectomy, a surgical procedure commonly used to treat lumbar disc herniation.

Materials and Methods Out of 484 patients who underwent minimally invasive microscopic discectomy between April 2018 and December 2022, 35 patients with a history of surgery at the same level were excluded, resulting in a total of 449 patients included in the study. Among them, 316 patients were treated using GTMS, whereas 133 were treated using collagen-based absorbable local hemostatic agents. Patient characteristics, surgical duration, intraoperative blood loss, postoperative drainage volume, intraoperative dural injury, and incidence of postoperative epidural hematoma were analyzed and compared between the two groups.

Results No significant differences in patient demographics were observed between the two groups, except for activated partial thromboplastin time and prothrombin time. Although there were no significant differences in the mean surgical time and intraoperative blood loss between the two groups, they tended to be shorter and less in the GTMS group (56.3 ± 20.2 vs. 58.2 ± 20.4 minutes [p = 0.36] and 10.0 ± 15.4 vs. 11.8 ± 8.3 g [p = 0.20]). The volume of postoperative drainage was significantly lower in the GTMS group than that in the comparison group (35.3 ± 21.8 vs. 49.5 ± 34.1 g [p < 0.01]). There was a trend indicating a difference in the number of intraoperative dural injuries and the need for reoperation due to postoperative epidural hematoma (2 vs. 3 ± 20.4 minutes [p = 0.21] and 1 vs. 2 [p = 0.16]).

Conclusion The use of a GTMS in minimally invasive microscopic discectomy appears to be beneficial in reducing postoperative drainage volume. It has also been shown that it may improve clinical outcomes such as intraoperative dural injury and postoperative epidural hematoma. Furthermore, further consideration of the medical economic impact is required.

Keywords

gelatin–thrombin matrix sealants - intraoperative blood loss - lumbar disc herniation - minimally invasive microscopic discectomy - postoperative drainage volume - tubular retractor

Authors' Contributions

Y.S. and S.N. designed the study; Y.S., T.O., and S.T. performed the experiments and analyzed the data; T.F., A.O., F.Y., Y.N., J.M., and T.A. conducted manuscript writing and provided guidance for statistical analysis; Y.S., T.O., and T.A. wrote the manuscript.


Ethical Approval

Ethical approval was waived by the ethics committee due to the retrospective study design.


Patients' Consent

Informed consent for all participants in this study was obtained through an opt-out process.




Publication History

Article published online:
12 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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