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Reduction of epidural fibrosis and dural adhesions after lamina reconstruction by absorbable cement: an experimental study
Authors:Mehdi Zeinalizadeh  Seyed Mojtaba Miri  Farid Azmoodeh Ardalan  Farid Maleki  Marjan Zakeri  Elham Aghajanzadeh  Zohreh Habibi
Institution:1. Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1419733141, Iran;2. Brain and Spinal Cord Injuries Repair Research Center, Imam Khomeini Hospital, Tehran 1419733141, Iran;3. Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1419733141, Iran;1. Department of Orthopaedics and Sports Medicine, University of South Florida, 13220 USF Laurel Dr, Tampa, FL 33612, USA;2. Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA;3. Center for Spinal Disorders, Florida Orthopaedic Institute, 13020 N. Telecom Parkway, Tampa, FL 33637, USA;1. ORA Orthopedics, 520 Valley View Drive #100, Moline, IL 61265, USA;2. Orthopaedic and Sports Medicine, Harborview Medical Center, 325 Ninth Ave., Box 359798, Seattle, WA 98104-2499, USA;1. Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 3021, Kansas City, KS 66160, USA;2. Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada;3. Toronto Western Hospital, 399 Bathurst St, #4W-449, Toronto, ON, Canada;4. Department of Health Services, University of Washington, Box 359455, 4333 Brooklyn Ave NE, Rm 14-315, Seattle, WA 98195-9455, USA;5. Department of Orthopaedic Surgery, Emory University, Emory Orthopaedics & Spine Center, 59 Executive Park South, Atlanta, GA 30329, USA;6. Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107-4216, USA;7. Department of Orthopaedics, University of Utah, University Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108, USA;8. Department of Neurological Surgery, University of Virginia Health System, PO Box 800212, Charlottesville, VA 22908-0212, USA;9. Department of Orthopedic Surgery, New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA;10. Boston Spine Group, 299 Washington St, Newton, MA 02458, USA;11. Department of Orthopaedics, University of Washington, Orthopaedic Trauma Surgery Clinic at Harborview, Harborview Medical Center, 1 West Clinic, Box 359798, 325 Ninth Ave, Seattle, WA 98104, USA;12. Spine Education and Research Institute, Center for Spinal Disorders, 9005 Grant St., Suite 200, Thornton, CO 80229, USA;13. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, 75 Francis St., Boston, MA 02115, USA;14. Department of Orthopedic Surgery, Indiana Spine Group, 8040 Clearvista Parkway, Suite 450, Indianapolis, IN 46256, USA;15. The CORE Institute, Center for Orthopedic Research and Education, 3010 W. Agua Fria Fwy #100, Phoenix, AZ 85027, USA;p. Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer 7-109, 600 North Wolfe St., Baltimore, MD 21287, USA;1. Department of Orthopaedic Surgery and Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA;2. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA;1. Clinica Ortopedica, University of Genoa, IRCCS A.O.U. San Martino – Ist, Genova, Largo R. Benzi 10, 16100, Italy;2. Ortopedia e Traumatologia d''urgenza, IRCCS A.O.U. San Martino – Ist, Genova, Largo R. Benzi 10, 16100, Italy
Abstract:Background contextPost-laminectomy epidural fibrosis complicates revision spine surgery and is implicated in cases of “failed back syndrome.” Several materials have been used to minimize epidural fibrosis with varying results.PurposeThe aim of this study was to examine the impact of reconstruction of laminectomy site with a type of absorbable cement (Jectos) to reduce epidural fibrosis.Study designThis investigation is an experimental controlled study, which is designed to evaluate the preventive effects of laminectomy site reconstruction in rat laminectomy model.MethodsTwenty wistar rats were included in this study and divided randomly to two equal groups, namely, subject and control. In both groups, laminectomy was performed in L2 and L4 levels. Control group received no additional treatment. In the subject group, L4 levels were reconstructed by Jectos and L2 levels were non-reconstructed as internal controls. Six months after surgery the rats were sacrificed and the dural adhesion and epidural fibrosis were evaluated macroscopically and microscopically. The study was financially supported by Brain and Spinal Cord Injuries Repair Center. None of the authors have any conflict of interest.ResultsNon-reconstructed levels in both groups showed dense epidural fibrosis with marked dural adherence. L4 reconstructed levels in subject group showed reduced epidural fibrosis macroscopically (p=.024) and microscopically (p=.041). No foreign body reaction or ossification occurred at reconstructed sites.ConclusionsIn the present study, lamina reconstruction with absorbable cement was a safe method that significantly reduced post-laminectomy epidural fibrosis and dural adhesions in rat laminectomy model.
Keywords:Epidural fibrosis  Dural adhesion  Laminectomy  Revision spine surgery  Lamina reconstruction
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