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.

Figures

Fig. 1

a Histology observation of AM by H&E staining (×100). b Magnified view of the black rectangle frame from a, demonstrating anatomic structure of AM (×400; EC epithelial cell, BM basement membrane, SM stromal matrix)

Fig. 2

Histology observation of laminectomy site in FAM (a), CAM (b), non-treatment (c), and AFF groups (d) by H&E staining at 1 week postoperatively (×100; CAM cross-linked amniotic membrane, FAM freeze–dried amniotic membrane, EH epidural hemorrhage, DM dura mater, NC neural cord, FT fat tissue)

Fig. 3

Histology observation of laminectomy site in FAM (a), CAM (b), non-treatment (c), and AFF groups (d) by H&E staining at 6 weeks postoperatively (×100; CAM cross-linked amniotic membrane, FAM freeze–dried amniotic membrane, EF epidural fibrosis, DM dura mater, NC neural cord, FT fat tissue, NB newly formed bone)

Fig. 4

Histology observation of laminectomy site in FAM (a), CAM (b), non-treatment (c), and AFF groups (d) by H&E staining at 12 weeks postoperatively (×100; CAM cross-linked amniotic membrane, FAM freeze–dried amniotic membrane, EF epidural fibrosis, DM dura mater, NC neural cord, FT fat tissue, NB newly formed bone)