P018: A CASE REPORT: EVALUATION OF WYDASE IN COMPLETE SCAR REMOVAL: EVIDENCE FROM MAGNETIC RESONANCE IMAGING AND CLINICAL APPLICATIONS
Helena Krogman; Yazan Chaiah; Jack Leal; Bryan J Stevens, MD; Sanjeev Kumar, MD
University of Florida
Wound healing is a complex and dynamic biological process encompassing hemostasis, inflammation, proliferation, and remodeling. However, the formation of fibrotic scars, characterized by disorganized extracellular matrix components such as collagen and fibroblasts, poses significant challenges, particularly in restrictive anatomical spaces such as the spinal canal. Fibrosis in the epidural space can result in nerve root or dural compression, leading to debilitating pain, neural dysfunction, and resultant morbidity. Transforming growth factor-beta (TGF-β) plays a pivotal role in the regulation of fibrotic processes, including the activation of fibroblasts and myofibroblasts.
Hyaluronic acid (HA) has demonstrated therapeutic potential in reducing fibrosis and managing pain in various contexts. The present case report highlights the innovative application of hyaluronidase, an enzyme that breaks down fibrotic adhesions, in managing symptomatic epidural fibrosis. We report the case of a 54-year-old female with a history of multiple spinal surgeries. MRI images in November 2020 revealed significant post-surgical scarring surrounding the traversing left S1 nerve root at the L5-S1 disc level, correlating with severe left S1 radiculopathy with weakness in left ankle plantarflexion and numbness in left S1 dermatome. The patient underwent a caudal epidural injection using a fluoroscopic guided catheter to target the left L5-S1 surgical bed and injection of the scar tissue area surrounding the S1 nerve root with hyaluronidase on May 11th 2023. A follow-up MRI on May 23rd 2023 demonstrated near total volumetric reduction in previous fibrotic lesion around the left S1 nerve which also corelated with the patient’s resolution of her left S1 radiculopathy symptoms of weakness and numbness of her left foot. This case underscores the potential of hyaluronidase as a therapeutic agent in addressing fibrotic scars in the spine, providing an alternative approach to improve outcomes for patients with post-laminectomy syndrome and related complications. Further research is warranted to elucidate its broader applications and long-term efficacy.