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A synthetic biomaterials approach to the prevention of postsurgical adhesions in neurosurgery

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TypeOfResource
Text
TitleInfo (ID = T-1)
Title
A synthetic biomaterials approach to the prevention of postsurgical adhesions in neurosurgery
Identifier
ETD_2904
Identifier (type = hdl)
http://hdl.rutgers.edu/1782.1/rucore10001600001.ETD.000056345
Language
LanguageTerm (authority = ISO639-2); (type = code)
eng
Genre (authority = marcgt)
theses
Subject (ID = SBJ-1); (authority = RUETD)
Topic
Biomedical Engineering
Subject (ID = SBJ-2); (authority = ETD-LCSH)
Topic
Nervous system--Surgery--Complications
Subject (ID = SBJ-3); (authority = ETD-LCSH)
Topic
Laminectomy
Subject (ID = SBJ-4); (authority = ETD-LCSH)
Topic
Electrospinning
Subject (ID = SBJ-5); (authority = ETD-LCSH)
Topic
Adhesives in surgery
Abstract (type = abstract)
In the treatment of spinal stenosis and disc herniation, the lamina and ligamentum flavum are resected to access the spinal canal. When a fibrous scar replaces the surgical defect, the dura or spinal nerves can become tethered to the surrounding tissues. Kuslich et al. and Smyth and Wright demonstrated that light mechanical stimulation of injured spinal nerves induced intraoperative or postoperative sciatic pain similar to the patients’ preoperative state [1, 2]. Therefore, adhesive peridural fibrosis contributes to the recurrence of back pain following neurosurgery. In this dissertation, biomaterial membranes are evaluated for the prevention of scar progression to the dura and spinal nerves. Cell-impermeable, biodegradable tyrosine-derived polycarbonate membranes were fabricated by electrospinning. A degradable surfactant, trans-4-hyroxy-L-proline butyl ester HCl, enabled electrospinning from a low toxicity solvent (acetic acid). Anti-adhesion membranes with a 1:1 composition of glassy and rubbery polymers were fabricated by a dual-spinneret technique, where the composite membrane’s suture retention strength, delamination strength, and toughness were greater than conventional electrospun fabrics. Controlled delivery of an antifibrotic, cis-4-hydroxy-L-proline, was achieved through synthesis of drug precursors. Hexyl- and octyl-ester precursors enabled diffusion-controlled release of the antifibrotic over 1 or more weeks, while cis-4-hydroxy-L-proline diffused from poly(DTE carbonate) films within 24 hours. Composite membranes with and without antifibrotic were compared against polymer films and Integra LifeSciences’ DuraGen PLUS® in a rat laminectomy model. The extent of adhesions was evaluated at 4 and 8 weeks. The fracture of polymeric films permitted scar progression to the dura by 8 weeks, despite inhibition at 4 weeks. The composite membranes did not fracture and reduced the extent of adhesion from 84% (control) to 36%. All adhesions in the composite membrane group formed at the caudal tuck, suggesting that performance could be improved by device fixation. Any effect of cis-4-hydroxy-L-proline was obscured by caudal instability. DuraGen PLUS® limited the extent of adhesion to 11%, and the adhesions present were comparatively light. In this dissertation, a synthetic degradable membrane was compared against polymeric films and DuraGen PLUS® in peridural adhesion prevention. The membrane possessed inherent barrier properties, superior mechanical properties, and the ability to deliver an antifibrotic. However, the device did not achieve anti-adheisve performance comparable to Integra LifeSciences’ DuraGen PLUS® in a rat laminectomy model due to the electrospun anti-adhesion membrane’s instability within the implantation site.
PhysicalDescription
Form (authority = gmd)
electronic resource
Extent
xxix, 189 p. : ill.
InternetMediaType
application/pdf
InternetMediaType
text/xml
Note (type = degree)
Ph.D.
Note (type = bibliography)
Includes bibliographical references
Note (type = vita)
Includes vita
Note (type = statement of responsibility)
by Charles A. Florek
Name (ID = NAME-1); (type = personal)
NamePart (type = family)
Florek
NamePart (type = given)
Charles A.
NamePart (type = date)
1980-
Role
RoleTerm (authority = RULIB)
author
DisplayForm
Charles Florek
Name (ID = NAME-2); (type = personal)
NamePart (type = family)
Kohn
NamePart (type = given)
Joachim B
Role
RoleTerm (authority = RULIB)
chair
Affiliation
Advisory Committee
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Joachim B Kohn
Name (ID = NAME-3); (type = personal)
NamePart (type = family)
Grumet
NamePart (type = given)
Martin
Role
RoleTerm (authority = RULIB)
internal member
Affiliation
Advisory Committee
DisplayForm
Martin Grumet
Name (ID = NAME-4); (type = personal)
NamePart (type = family)
Moghe
NamePart (type = given)
Prabhas V
Role
RoleTerm (authority = RULIB)
internal member
Affiliation
Advisory Committee
DisplayForm
Prabhas V Moghe
Name (ID = NAME-5); (type = personal)
NamePart (type = family)
Levene
NamePart (type = given)
Howard B
Role
RoleTerm (authority = RULIB)
outside member
Affiliation
Advisory Committee
DisplayForm
Howard B Levene
Name (ID = NAME-1); (type = corporate)
NamePart
Rutgers University
Role
RoleTerm (authority = RULIB)
degree grantor
Name (ID = NAME-2); (type = corporate)
NamePart
Graduate School - New Brunswick
Role
RoleTerm (authority = RULIB)
school
OriginInfo
DateCreated (qualifier = exact)
2010
DateOther (qualifier = exact); (type = degree)
2010-10
Place
PlaceTerm (type = code)
xx
RelatedItem (type = host)
TitleInfo
Title
Rutgers University Electronic Theses and Dissertations
Identifier (type = RULIB)
ETD
RelatedItem (type = host)
TitleInfo
Title
Graduate School - New Brunswick Electronic Theses and Dissertations
Identifier (type = local)
rucore19991600001
Location
PhysicalLocation (authority = marcorg); (displayLabel = Rutgers, The State University of New Jersey)
NjNbRU
Identifier (type = doi)
doi:10.7282/T3GF0T8F
Genre (authority = ExL-Esploro)
ETD doctoral
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Rights

RightsDeclaration (AUTHORITY = GS); (ID = rulibRdec0006)
The author owns the copyright to this work.
Copyright
Status
Copyright protected
Availability
Status
Open
Reason
Permission or license
RightsHolder (ID = PRH-1); (type = personal)
Name
FamilyName
Florek
GivenName
Charles
Role
Copyright Holder
RightsEvent (ID = RE-1); (AUTHORITY = rulib)
Type
Permission or license
DateTime
2010-09-25 20:39:22
AssociatedEntity (ID = AE-1); (AUTHORITY = rulib)
Role
Copyright holder
Name
Charles Florek
Affiliation
Rutgers University. Graduate School - New Brunswick
AssociatedObject (ID = AO-1); (AUTHORITY = rulib)
Type
License
Name
Author Agreement License
Detail
I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
RightsEvent (ID = RE-2); (AUTHORITY = rulib)
Type
Embargo
DateTime
2010-10-31
Detail
Access to this PDF has been restricted at the author's request. It will be publicly available after October 31st, 2011.
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Technical

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ETD
MimeType (TYPE = file)
application/pdf
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application/x-tar
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7188480
Checksum (METHOD = SHA1)
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