Postoperative fibrosis after surgical treatment of the porcine spinal cord: a comparison of dural substitutes

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> Postoperative adhesion- and fibrosis-induced spinal cord tethering is not uncommon and may be associated with delayed clinical sequelae. Multiple dural substitutes have been used in surgery without a full appreciation of the grafts' adverse effects. The authors conducted a comparative animal experimental study to evaluate the degree of chronic inflammatory reactions, adhesions, and fibrosis caused by the use of four dural substitutes—Surgicel, Durasis, DuraGen, and Preclude.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Twenty-six pigs weighing 30 to 40 kg underwent a two-level lumbar laminectomy (a midline durotomy, implantation of a 2-cm dural substitute in the subarachnoid space, and watertight dural closure). After 8 weeks the animals were killed, and two independent neuropathologists blinded to the dural substitute group evaluated several sites along the implants, providing descriptions and quantitative scoring of fibrosis, chronic inflammatory reactions, foreign-body reactions, and spinal cord changes. Kruskal—Wallis one-way analysis of variance for ranks corrected for multiple comparisons was used to examine differences among the materials.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The DuraGen dural substitute produced the least amount of inflammation in the subarachnoid space and Preclude generated the most (p &lt; 0.001). Surgicel and DuraGen were completely resorbed on histological sections, but both produced some inflammation, which diminished gradually from the dural implant center. Histological evaluation of the nonresorbed grafts demonstrated that Durasis caused the least degree of inflammatory cell infiltration (p &lt; 0.001). The Preclude dural substitute consistently demonstrated encapsulation and arachnoidal reaction. There was no evidence of implant-related adverse effects on the underlying pia mater and white matter regardless of the substitute type.</jats:p>

Bilayer oxidized regenerated cellulose/poly ε-caprolactone knitted fabric-reinforced composite for use as an artificial dural substitute

“…It completely absorbed within 2 weeks after implantation in a porcine model and did not produce any foreign-body reactions [20]. Poly ecaprolactone (PCL) is a semi-crystalline aliphatic polyester that has been used in a number of medical products with a wide range of applications including drug delivery system, medical devices and tissue engineering applications [21].…”

Biologic scaffolds composed of central nervous system extracellular matrix

“…There is clinical precedent for the application of ECM scaffolds in reconstruction of central nervous system (CNS) structures [25,26], but the development of ECM scaffolds for CNS regenerative medicine strategies has received relatively scarce attention [27–29]. It has been suggested that ECM harvested from specific tissues is the preferred substrate for cells native to those respective tissues if maintenance of phenotypic characteristics is important [3–8,30].…”

Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Con­trol Trial

“…Consequently, epidural fibrosis may be a causative factor in at least 20% to 36% of all cases for failed back surgery syndrome 24-26. Further, experiments in post lumbar laminectomy syndrome in animal models have illustrated paraspinal muscle spasms, tail contractures, pain behaviors, tactile allodynia, epidural and perineural scarring, and nerve root adherence to the underlying discs and pedicle 38,39.…”