Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Abstract

Postlaminectomy epidural adhesion is implicated as a main cause of ''failed back surgery syndrome'' and associated with increased risk of complications during revision surgery. Various materials acting as mechanical barriers to reduce fibroblasts infiltration into epidural space have met with limited success. In present research, amniotic membrane (AM) was studied to investigate its effects on reducing epidural scar adhesion after laminectomy in a canine model. Laminectomy sites were created at L-1, L-3, L-5, and L-7 levels in 24 adult mongrel dogs. Freeze dried AM (FAM), cross-linked AM (CAM), and autologous free fat (AFF) were implanted, respectively, at a randomly assigned site in each dog with the remaining untreated site serving as internal control. The animals were sacrificed at 1, 6, and 12 weeks postoperatively. Then, gross pathologic observation including scar amount and adhesion tenacity, qualitative histology evaluation, and quantitative histology analysis were compared. Gross observation demonstrated that scar amount and adhesion tenacity of CAM group were significantly lower in comparison with those of FAM and non-treatment groups. A white, slightly vascularized CAM layer covered the dura mater without tenacious scar adhesion. The histology analysis also indicated reduced fibroblasts infiltration and consequent epidural fibrosis, which were similar to the results of AFF group. In conclusion, the CAM is effective in reducing epidural fibrosis and scar adhesion after laminectomy in canine model. It is a promising biomaterial for future clinical applications.

Effects of cepae extract, allantoin, and heparin mixture on developing andalready formed epidural fibrosis in a rat laminectomy model

“…It is possible to remove extensive epidural scar adhesions and release the tethered nerve roots with revision surgery but the adhesions unfortunately recur afterwards (25,26). A treatment that can reduce epidural fibrosis and scar adhesions reliably and without side effects is therefore needed.…”

In situ forming oxidised hyaluronic acid/adipic acid dihydrazide hydrogel for prevention of epidural fibrosis after laminectomy

“…The number of fibroblasts was counted and the average recorded for all 12 rats (2 laminectomy level in each rat, with one being treatment group and the other control group), repeating the procedure for three fields per sample (one from the middle of the laminectomy area and two from the margins, one on each side). The cell counting resulting for each group was expressed in cell number per mm 2 (Tao and Fan, 2009). …”

Evaluation of Dehydrated Human Amnion/Chorion Membrane as an Adhesion Barrier in Women Undergoing Robotic Laparoscopy

“…Amniotic membrane has inherent properties including being immune privileged, and having the ability to modulate inflammation and reduce scar tissue formation [2][3][4][5]. Such properties present significant therapeutic potential for use of amniotic membrane during wound healing, tissue repair, and regenerative therapy [2][3][4][5].…”

“…Animal studies have shown that implanting amniotic membrane reduces postlaminectomy epidural adhesions, as well as periotoneal adhesions [3,12].…”