The Effect of Interposition Membrane on the Outcome of Lumbar Laminectomy and Discectomy

Mackay, Michael A.; Fischgrund, Jeffrey S.; Herkowitz, Harry N.; Kurz, Lawrence T.; Hecht, Brian; Schwartz, Michael L.

doi:10.1097/00007632-199508150-00008

Cited by 72 publications

(45 citation statements)

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“…However, none of them has been widely accepted with consistent results. Now, only some materials, such as Gelform, Adcon-L, and fat grafts are applied in humans with limited success [6,8,20]. The associated complications include cerebrospinal fluid leaks, seroma formation, scar dimpling, and migration of fat graft [10,24,37].…”

Section: Introductionmentioning

confidence: 99%

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Huang

Fan

2009

Eur Spine J

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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.

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Section: Introductionmentioning

confidence: 99%

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Huang

Fan

2009

Eur Spine J

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“…There is no consensus on the effectiveness of surgery. Some authors rule out this possibility [4,17,23] and others recommend, such as, a last resort in patients with incapacitating pain [18,20,22].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, NSAIDs inhibit cyclooxygenase, which is responsible for the synthesis of prostaglandins (biological mediators capable of triggering reactions of vasodilation and chemotaxis). The beneficial effect of the NSAIDs in the prevention of the calcifications of the soft tissues, heterotopic ossifications and adherences is well-known [10,20].…”

Section: Introductionmentioning

confidence: 99%

Preventing peridural fibrosis with nonsteroidal anti-inflammatory drugs

Sandoval

Hernández-Vaquero

2008

Eur Spine J

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Peridural fibrosis is one of the more frequent complications of lumbar surgery. Nonsteroidal antiinflammatory drugs inhibit the inflammatory and fibroblastic response. We performed lumbar laminectomies in 24 rabbits, divided into two groups. The experimental group received 5 mg/kg/day of aceclofenac for 7 days and the control group received 1 cm 3 of physiological saline. The samples were stained using immunohistochemical methods. The cellular populations in the inflammatory reaction and the thickness of the fibrous membrane were quantified. The mean of the fibrous area was always less in the rabbits of the experimental group compared to controls (47% less at 2 weeks and 41% less at 4 weeks). We observed an 8% decrease in the number of fibroblasts with antivimentin monoclonal antibodies in the experimental group. In this model, aceclofenac inhibits the presence of inflammatory cells in the fibrous scar in the early stages and reduces the extension of adhesions without adverse reactions.

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“…10 However, consequently studies showed no evidence that Gelfoam prevented the ingrowth of scar tissue. 2,8,13,15 The new foamy materials such as viscous (1.9%) Na hyaluronate solution, 9 absorbable gel matrix comprising absorbable gelatine and carbohydrate polymer (ADCON-L) 5,21 reduced peridural scar tissue in the animal model. Later studies showed that autogenous free fat graft was more e ective in preventing scar tissue.…”

Section: Discussionmentioning

confidence: 99%

The barrier effect of laminae: laminotomy versus laminectomy

et al. 2000

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Study design: An experimental study to investigate whether replacement of the laminae (laminotomy) after subliminal procedures can prevent the invasion of scar tissue towards the dura. Setting: Izmir, Turkey. Methods: Laminectomy and laminotomy were performed at di erent levels on seven rats. Their spinal columns were investigated histopathologically after a period of 3 months. Results: The histopathological evaluation revealed that the dura and spinal cord were involved by scar tissue at laminectomy area. However, this invasion was not observed at laminotomy levels. This study showed the barrier e ect of laminae against ®broblastic activity. Conclusion:The barrier e ect of lamina may a ect the surgical outcome related to epidural ®brosis. Spinal Cord (2000) 38, 442 ± 444

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The Effect of Interposition Membrane on the Outcome of Lumbar Laminectomy and Discectomy

Cited by 72 publications

References 0 publications

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Preventing peridural fibrosis with nonsteroidal anti-inflammatory drugs

The barrier effect of laminae: laminotomy versus laminectomy

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