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

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Iftikharul HaqThe Miami Project to Cure Paralysis and the Departments of Neurosurgery and Neuropathology, University of Miami School of Medicine, Miami, Florida

Search for other papers by Iftikharul Haq in
jns
Google Scholar
PubMed
Close
 M.D.
,
Yenisel Cruz-AlmeidaThe Miami Project to Cure Paralysis and the Departments of Neurosurgery and Neuropathology, University of Miami School of Medicine, Miami, Florida

Search for other papers by Yenisel Cruz-Almeida in
jns
Google Scholar
PubMed
Close
 M.S.P.H.
,
Edir B. SiqueiraThe Miami Project to Cure Paralysis and the Departments of Neurosurgery and Neuropathology, University of Miami School of Medicine, Miami, Florida

Search for other papers by Edir B. Siqueira in
jns
Google Scholar
PubMed
Close
 M.D., Ph.D.
,
Michael NorenbergThe Miami Project to Cure Paralysis and the Departments of Neurosurgery and Neuropathology, University of Miami School of Medicine, Miami, Florida

Search for other papers by Michael Norenberg in
jns
Google Scholar
PubMed
Close
 M.D.
,
Barth A. GreenThe Miami Project to Cure Paralysis and the Departments of Neurosurgery and Neuropathology, University of Miami School of Medicine, Miami, Florida

Search for other papers by Barth A. Green in
jns
Google Scholar
PubMed
Close
 M.D.
, and
Allan D. LeviThe Miami Project to Cure Paralysis and the Departments of Neurosurgery and Neuropathology, University of Miami School of Medicine, Miami, Florida

Search for other papers by Allan D. Levi in
jns
Google Scholar
PubMed
Close
 M.D., Ph.D.
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $384.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $384.00
USD  $624.00
Print or Print + Online Sign in

Object. 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.

Methods. 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.

Conclusions. The DuraGen dural substitute produced the least amount of inflammation in the subarachnoid space and Preclude generated the most (p < 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 < 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.

  • Collapse
  • Expand
  • 1.

    Aliredjo RP, , de Vries J, , Menovsky T, , Grotenhuis JA, & Merx J: The use of Gore-Tex membrane for adhesion prevention in tethered spinal cord surgery: technical case reports. Neurosurgery 44:674678, 1999 Aliredjo RP, de Vries J, Menovsky T, Grotenhuis JA, Merx J: The use of Gore-Tex membrane for adhesion prevention in tethered spinal cord surgery: technical case reports. Neurosurgery 44:674–678, 1999

    • Search Google Scholar
    • Export Citation
  • 2.

    Alleyne CH Jr, & Barrow DL: Immune response in hosts with cadaveric dural grafts. Report of two cases. J Neurosurg 81:610613, 1994 Alleyne CH Jr, Barrow DL: Immune response in hosts with cadaveric dural grafts. Report of two cases. J Neurosrg 81:610–613, 1994

    • Search Google Scholar
    • Export Citation
  • 3.

    Badylak SF: Small intestinal mucosa (SIS): a biomaterial conducive to smart tissue modeling, in Bell E (ed): Tissue Engineering: Current Perspectives. Boston: Birkhäuser, 1993, Vol 4, pp 179189 Badylak SF: Small intestinal mucosa (SIS): a biomaterial conducive to smart tissue modeling, in Bell E (ed): Tissue Engineering: Current Perspectives. Boston: Birkhäuser, 1993, Vol 4, pp 179–89

    • Search Google Scholar
    • Export Citation
  • 4.

    Boot DA, & Hughes SP: The prevention of adhesions after laminectomy. Adverse results of Zenoderm implantations into laminectomy sites in rabbits. Clin Orthop 215:296302, 1987 Boot DA, Hughes SP: The prevention of adhesions after laminectomy. Adverse results of Zenoderm implantations into laminectomy sites in rabbits. Clin Orthop 215:296–302, 1987

    • Search Google Scholar
    • Export Citation
  • 5.

    Cobb MA, , Badylak SF, , Janas W, & Boop FA: Histology after dural grafting with small intestinal submucosa. Surg Neurol 46:389394, 1996 Cobb MA, Badylak SF, Janas W, Boop FA: Histology after dural grafting with small intestinal submucosa. Surg Neurol 46:389–394, 1996

    • Search Google Scholar
    • Export Citation
  • 6.

    Collins RL, , Christiansen D, , Zazanis GA, & Silver FH: Use of collagen film as a dural substitute: preliminary animal studies. J Biomed Mater Res 25:267276, 1991 Collins RL, Christiansen D, Zazanis GA, Silver FH: Use of collagen film as a dural substitute: preliminary animal studies. J Biomed Mater Res 25:267–276, 1991

    • Search Google Scholar
    • Export Citation
  • 7.

    Dubin LM, , Quencer AM, & Green BA: A mimicker of a postoperative spinal mass: Gelfoam in a laminectomy site. Am J Neuroradiol 9:217218, 1988 (Letter) Dubin LM, Quencer AM, Green BA: A mimicker of a postoperative spinal mass: Gelfoam in a laminectomy site. Am J Neuroradiol 9:217–218, 1988 (Letter)

    • Search Google Scholar
    • Export Citation
  • 8.

    DuraGen Instructions for Use, Integra Life Sciences Corporation. 1999. (http://www.Integra-Neuroscience.com) [Accessed October 2004] DuraGen Instructions for Use, Integra Life Sciences Corporation. 1999. (http://www.Integra-Neuroscience.com) [Accessed October 2004]

  • 9.

    Ethicon, a Johnson & Johnson company: SURGICEL Absorbable Hemostat. (http: //www.jnjgateway.com/home.jhtml?page=viewContent&contentId=fc0de00100000816&loc=USENG) [Accessed November 2003] Ethicon, a Johnson & Johnson company: SURGICEL Absorbable Hemostat. (http: //www.jnjgateway.com/home.jhtml?page=viewContent&contentId=fc0de00100000816&loc=USENG) [Accessed November 2003]

  • 10.

    Görtler M, , Braun M, , Becker I, , Roggendorf W, , Heiss E, & Grote E: Animal experiments with a new dura graft (polytetrafluoroethylene)—results. Neurochirurgia (Stuttg) 34:103106, 1991 Görtler M, Braun M, Becker I, Roggendorf W, Heiss E, Grote E: Animal experiments with a new dura graft (polytetrafluoroethylene)—results. Neurochirurgia (Stuttg) 34:103–106, 1991

    • Search Google Scholar
    • Export Citation
  • 11.

    Inoue HK, , Kobayashi S, , Ohbayashi K, , Kohga H, & Nakamura M: Treatment and prevention of tethered and retethered spinal cord using a Gore-Tex surgical membrane. J Neurosurg 80:689693, 1994 Inoue HK, Kobayashi S, Ohbayashi K, Kohga H, Nakamura M: Treatment and prevention of tethered and retethered spinal cord using a Gore-Tex surgical membrane. J Neurosurg 80:689–693, 1994

    • Search Google Scholar
    • Export Citation
  • 12.

    Keller JT, , Dunsker SB, , McWhorter JM, , Ongkiko CM, , Saunders MC, & Mayfield FH: The fate of autogenous grafts to the spinal dura. An experimental study. J Neurosurg 49:412418, 1978 Keller JT, Dunsker SB, McWhorter JM, Ongkiko CM, Saunders MC, Mayfield FH: The fate of autogenous grafts to the spinal dura. An experimental study. J Neurosurg 49:412–418, 1978

    • Search Google Scholar
    • Export Citation
  • 13.

    Keller JT, , Ongkiko CM Jr, , Saunders MC, , Mayfield FH, & Dunsker SB: Repair of spinal dural defects. An experimental study. J Neurosurg 60:10221028, 1984 Keller JT, Ongkiko CM Jr, Saunders MC, Mayfield FH, Dunsker SB: Repair of spinal dural defects. An experimental study. J Neurosurg 60:1022–1028, 1984

    • Search Google Scholar
    • Export Citation
  • 14.

    Martinez-Lage JF, , Sola J, , Poza M, & Esteban JA: Pediatric Creutzfeldt-Jakob disease: probable transmission by a dural graft. Childs Nerv Syst 9:239242, 1993 Martinez-Lage JF, Sola J, Poza M, Esteban JA: Pediatric Creutzfeldt-Jakob disease: probable transmission by a dural graft. Childs Nerv Syst 9:239–242, 1993

    • Search Google Scholar
    • Export Citation
  • 15.

    Mayfield FH: Autologous fat transplant for the protection and repair of the spinal dura. Clin Neurosurg 27:349361, 1980 Mayfield FH: Autologous fat transplant for the protection and repair of the spinal dura. Clin Neurosurg 27:349–361, 1980

    • Search Google Scholar
    • Export Citation
  • 16.

    Naotam PK, , Van Dellen JR, & Bhoola KD: A clinicopathological study of collagen sponge as a dural graft in neurosurgery. J Neurosurgery 82:406412, 1995 Naotam PK, Van Dellen JR, Bhoola KD: A clinicopathological study of collagen sponge as a dural graft in neurosurgery. J Neurosurgery 82:406–412, 1995

    • Search Google Scholar
    • Export Citation
  • 17.

    Park YK, & Tator CH: Prevention of arachnoiditis and postoperative tethering of the spinal cord with Gore-Tex surgical membrane: an experimental study with rats. Neurosurgery 42:813824, 1998 Park YK, Tator CH: Prevention of arachnoiditis and postoperative tethering of the spinal cord with Gore-Tex surgical membrane: an experimental study with rats. Neurosurgery 42:813–824, 1998

    • Search Google Scholar
    • Export Citation
  • 18.

    Robertson JT, , Meric AL, , Dohan FC Jr, , Schweitzer JB, , Wujek JR, & Ahmad S: The reduction of postlaminectomy peridural fibrosis in rabbits by a carbohydrate polymer. J Neurosurg 79:8995, 1993 Robertson JT, Meric AL, Dohan FC Jr, Schweitzer JB, Wujek JR, Ahmad S: The reduction of postlaminectomy peridural fibrosis in rabbits by a carbohydrate polymer. J Neurosurg 79:89–95, 1993

    • Search Google Scholar
    • Export Citation
  • 19.

    Tator CH: Pathophysiology and pathology of spinal cord injury, in Wilkins RH, & Rengachary SS (eds): Neurosurgery, ed 2. New York: McGraw-Hill, 1996, pp 28472859 Tator CH: Pathophysiology and pathology of spinal cord injury, in Wilkins RH, Rengachary SS (eds): Neurosurgery, ed 2. New York: McGraw-Hill, 1996, pp 2847–2859

    • Search Google Scholar
    • Export Citation
  • 20.

    Tator CH: Update on the pathophysiology and pathology of acute spinal cord injury. Brain Pathol 5:407413, 1995 Tator CH: Update on the pathophysiology and pathology of acute spinal cord injury. Brain Pathol 5:407–413, 1995

    • Search Google Scholar
    • Export Citation
  • 21.

    Thammavaram KV, , Benzel EC, & Kesterson L: Fascia lata graft as a dural substitute in neurosurgery. South Med J 83:634636, 1990 Thammavaram KV, Benzel EC, Kesterson L: Fascia lata graft as a dural substitute in neurosurgery. South Med J 83:634–636, 1990

    • Search Google Scholar
    • Export Citation
  • 22.

    Vinas FC, , Ferris D, , Kupsky WJ, & Dujovny M: Evaluation of expanded polytetrafluoroethylene (ePTFE) versus polydioxanone (PDS) for the repair of dura mater defects. Neurol Res 21:262268, 1999 Vinas FC, Ferris D, Kupsky WJ, Dujovny M: Evaluation of expanded polytetrafluoroethylene (ePTFE) versus polydioxanone (PDS) for the repair of dura mater defects. Neurol Res 21:262–268, 1999

    • Search Google Scholar
    • Export Citation
  • 23.

    W.L. Gore & Associates, Inc: PRECLUDE Dura Substitute. (http: //www.goremedical.com/English/Products/PrecludeDura/Index.htm) [Accessed November 2003] W.L. Gore & Associates, Inc: PRECLUDE Dura Substitute. (http: //www.goremedical.com/English/Products/PrecludeDura/Index.htm) [Accessed November 2003]

    • Search Google Scholar
    • Export Citation
  • 24.

    Yamagata S, , Goto K, , Oda Y, & Kikuchi H: Clinical experience with expanded polytetrafluoroethylene sheet used as an artificial dura mater. Neurol Med Chir (Tokyo) 33:582585, 1993 Yamagata S, Goto K, Oda Y, Kikuchi H: Clinical experience with expanded polytetrafluoroethylene sheet used as an artificial dura mater. Neurol Med Chir (Tokyo) 33:582–585, 1993

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 828 191 19
Full Text Views 456 117 10
PDF Downloads 119 18 2
EPUB Downloads 0 0 0