NOVEL ARTIFICIAL LAMINA FOR PREVENTION OF EPIDURAL ADHESIONS AFTER POSTERIOR CERVICAL LAMINECTOMY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUuml ^1,2 , Chaoliang ¹ , SONG Yueming ¹ , LIU Hao ¹ , LIU Limin ¹ , GONG Quan ¹ , LI Tao ¹ , ZENG Jiancheng ¹ , KONG Qingquan ¹ , PEI Fuxing ¹ , TU Chongqi ¹

1Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;;
2Department of Orthopedics, the First People’s Hospital of Jining. Corresponding author: SONG Yueming, E-mail: sym_cd@yahoo.com.cn;

Corresponding author：

Keywords：

Nano-hydroxyapatite Multi-amino-acid copolymer; Artificial lamina; Scar tissue; Laminectomy; Goat

DOI：

10.7507/1002-1892.20130182

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Objective To evaluate the application of artificial lamina of multi-amino-acid copolymer (MAACP)/nano-hydroxyapatite (n-HA) in prevention of epidural adhesion and compression of scar tissue after posterior cervical laminectomy. Methods Fifteen 2-year-old male goats [weighing, (30 ± 2) kg] were randomly divided into experimental group (n=9) and control group (n=6). In the experimental group, C4 laminectomy was performed, followed by MAACP/n-HA artificial lamina implantations; in the control group, only C4 laminectomy was performed. At 4, 12, and 24 weeks after operation, 2, 2, and 5 goats in the experimental group and 2, 2, and 2 goats in the control group were selected for observation of wound infection, artificial laminar fragmentation and displacement, and its shape; Rydell’s degree of adhesion criteria was used to evaluate the adhesion degree between 2 groups. X-ray and CT images were observed; at 24 weeks after operation, CT scan was used to measure the spinal canal area and the sagittal diameter of C3, C4, and C5 vertebrea, 2 normal goats served as normal group; and MRI was used to assess adhesion and compression of scar tissue on the dura and the nerve root. Then goats were sacrificed and histological observation was carried out. Results After operation, the wound healed well; no toxicity or elimination reaction was observed. According to Rydell’s degree of adhesion criteria, adhesion in the experimental group was significantly slighter than that in the control group (Z= — 2.52, P=0.00). X-ray and CT scan showed that no dislocation of artificial lamina occurred, new cervical bone formed in the defect, and bony spinal canal was rebuilt in the experimental group. Defects of C4 vertebral plate and spinous process were observed in the control group. At 24 weeks, the spinal canal area and sagittal diameter of C4 in the experimental group and normal group were significantly larger than those in the control group (P lt; 0.05), but no significant difference was found between experimental group and normal group (P gt; 0.05). MRI showed cerebrospinal fluid signal was unobstructed and no soft tissue projected into the spinal canal in the experimental group; scar tissue projected into the spinal canal and the dura were compressed by scar tissue in the control group. HE staining and Masson trichrome staining showed that artificial lamina had no obvious degradation with high integrity, some new bone formed at interface between the artificial material and bone in the experimental group; fibrous tissue grew into defect in the control group. Conclusion The MAACP/n-HA artificial lamina could maintaine good biomechanical properties for a long time in vivo and could effectively prevent the epidural scar from growing in the lamina defect area.

Citation： LUuml,Chaoliang,SONG Yueming,LIU Hao,LIU Limin,GONG Quan,LI Tao,ZENG Jiancheng,KONG Qingquan,PEI Fuxing,TU Chongqi,DUAN Hong. NOVEL ARTIFICIAL LAMINA FOR PREVENTION OF EPIDURAL ADHESIONS AFTER POSTERIOR CERVICAL LAMINECTOMY. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(7): 829-835. doi: 10.7507/1002-1892.20130182 Copy

1.	LaRocco H, Macnab I. The laminectomy membrane. J Bone Joint Surg (Br), 1974, 56B(3): 545-550.
2.	Bosscher HA, Heavner JE. Incidence and severity of epidural fibrosis after back surgery: an endoscopic study. Pain Pract, 2010, 10(1): 18-24.
3.	Welch WC, Thomas KA, Cornwall GB, et al. Use of polylactide resorbable film as an adhesion barrier. J Neurosurg, 2002, 97(4 Suppl): 413-422.
4.	Tang X, Yang SH, Xu WH, et al. Vertebral plate regeneration induced by radiation-sterilized allogeneic bone sheets in sheep. Chin J Traumatol, 2007, 10(1): 34-39.
5.	Rydell NW, Balais EA. Effect of intra-articular injection of hyaluronic acid on the clinical sysnptoms of osteoarthritis and on granulation tissue formation. Clin Orthop Relat Res, 1971, 80: 25-32.
6.	Ran B, Song YM, Liu H, et al. Novel biodegradable a-TCP/poly (amino acid) composite artificial lamina following spinal surgery for prevention of intraspinal scar adhesion. Eur Spine J, 2011, 20(12): 2240-2246.
7.	Lawson KJ, Malycky J, Berry JL, et al. Lamina repair and replacement to control laminectomy membrane formation in dogs. Spine (Phila Pa 1976), 1991, 16(6 Suppl): S222-226.
8.	Su C, Yao C, Lu S, et al. Study on the optimal concentration of topical mitomycin-C in preventing postlaminectomy epidural adhesion. Eur J Pharmacol, 2010, 640(1-3): 63-67.
9.	Yu CH, Lee JH, Baek HR, et al. The effectiveness of poloxamer 407-based new anti-adhesive material in a laminectomy model in rats. Eur Spine J, 2012, 21(5) : 971-979.
10.	Richards PJ, Turner AS, Gisler SM, et al. Reduction in postlaminectomy epidural adhesions in sheep using a fibrin sealant-based medicated adhesion barrier. J Biomed Mater Res B Appl Biomater, 2010, 92(2): 439-446.
11.	Villavicencio AT, Nelson EL, Burneikiene S, et al. Surgical treatment strategies for the previously operated lumbar spine. Contemporary Spine Surgery, 2012, 13(1): 1-7.
12.	侯筱魁, 樊天佑. 透明质酸钠预防术后硬膜外粘连的组织学和超微结构研究. 中华骨科杂志, 1998, 18(5): 301-303.
13.	倪彬, 侯春林, 贾连顺, 等. 几丁质膜引导兔桡骨缺损骨再生的实验研究. 中华骨科杂志, 1995, 15(9): 607-609.
14.	Keskin F, Esen H. Comparison of the effects of an adhesion barrier and chitin on experimental epidural fibrosis. Turk Neurosurg, 2010, 20(4): 457-463.
15.	Jacobs RR, McClain O, Neff J. Control of postlaminectomy scar formation. An experimental and clinical study. Spine (Phila Pa 1976), 1980, 5(3): 223-229.
16.	Lladó A, Sologaistua E, Guimerá J, et al. Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: a clinical study. Eur Spine J, 1999, 8(2): 144-150.
17.	Wang J, Chen W, Li Y, et al. Biological evaluation of biphasic calcium phosphate ceramic vertebral laminae. Biomaterials, 1998, 19(15): 1387-1392.
18.	李玉宝. 纳米生物医药材料. 北京: 化学工业出版社, 2004: 36-40．.
19.	唐文胜, 蒋电明, 安洪, 等. 纳米羟基磷灰石/聚酰胺复合人工椎板预防脊柱后路术后椎管内瘢痕粘连的实验研究. 中国脊柱脊髓杂志, 2005, 15(11): 675- 678.
20.	蒋电明, 权正学, 黄伟, 等. 纳米羟基磷灰石/聚酰胺66复合生物活性人工椎板的初步临床应用. 中国修复重建外科杂志, 2007, 21(5): 441-444.
21.	周春光, 宋跃明, 屠重棋, 等. 可降解多元氨基酸共聚物/磷酸钙复合材料椎间融合器植入山羊颈椎即刻稳定性的生物力学评价. 生物医学工程学杂志, 2011, 28(1): 63-66.
22.	Yu C, Kohn J. Tyrosine-PEG-derived poly (ether carbonate)s as new biomaterials. Biomaterials, 1999, 20(3): 253-264.
23.	Rokkanen PU, Bostman O, Hirvensalo E, et al. Bioabsorbable fixation in orthopaedic surgery and traumatology. Biomaterials, 2002, 21(24): 2607-2613.
24.	Wei J, Li YB, Chen WQ, et al. A study on nano-composite of hydroxyapatite and polyamide. J Mater Sci, 2003, 38(15): 3303-3306．.
25.	Gupta HS, Seto J, Wagermaier W, et al. Cooperative deformation of mineral and collagen in bone at the nanoscale. Proc Natl Acad Sci U S A, 2006, 103(47): 17741-17746.
26.	Urist MR, Mclean FC. Recent advances in physiology of bone. J Bone Joint Surg (Am), 1963, 45: 1305-1313.
27.	Caroli E, Orlando ER, D’Andrea G, et al. Anterior cervical fusion with interbody titanium cage containing surgical bone site graft: our institution’s experience in 103 consecutive cases of degenerative spondylosis. Spinal Disord Tech, 2007, 20(3): 216-220.

1. LaRocco H, Macnab I. The laminectomy membrane. J Bone Joint Surg (Br), 1974, 56B(3): 545-550.
2. Bosscher HA, Heavner JE. Incidence and severity of epidural fibrosis after back surgery: an endoscopic study. Pain Pract, 2010, 10(1): 18-24.
3. Welch WC, Thomas KA, Cornwall GB, et al. Use of polylactide resorbable film as an adhesion barrier. J Neurosurg, 2002, 97(4 Suppl): 413-422.
4. Tang X, Yang SH, Xu WH, et al. Vertebral plate regeneration induced by radiation-sterilized allogeneic bone sheets in sheep. Chin J Traumatol, 2007, 10(1): 34-39.
5. Rydell NW, Balais EA. Effect of intra-articular injection of hyaluronic acid on the clinical sysnptoms of osteoarthritis and on granulation tissue formation. Clin Orthop Relat Res, 1971, 80: 25-32.
6. Ran B, Song YM, Liu H, et al. Novel biodegradable a-TCP/poly (amino acid) composite artificial lamina following spinal surgery for prevention of intraspinal scar adhesion. Eur Spine J, 2011, 20(12): 2240-2246.
7. Lawson KJ, Malycky J, Berry JL, et al. Lamina repair and replacement to control laminectomy membrane formation in dogs. Spine (Phila Pa 1976), 1991, 16(6 Suppl): S222-226.
8. Su C, Yao C, Lu S, et al. Study on the optimal concentration of topical mitomycin-C in preventing postlaminectomy epidural adhesion. Eur J Pharmacol, 2010, 640(1-3): 63-67.
9. Yu CH, Lee JH, Baek HR, et al. The effectiveness of poloxamer 407-based new anti-adhesive material in a laminectomy model in rats. Eur Spine J, 2012, 21(5) : 971-979.
10. Richards PJ, Turner AS, Gisler SM, et al. Reduction in postlaminectomy epidural adhesions in sheep using a fibrin sealant-based medicated adhesion barrier. J Biomed Mater Res B Appl Biomater, 2010, 92(2): 439-446.
11. Villavicencio AT, Nelson EL, Burneikiene S, et al. Surgical treatment strategies for the previously operated lumbar spine. Contemporary Spine Surgery, 2012, 13(1): 1-7.
12. 侯筱魁, 樊天佑. 透明质酸钠预防术后硬膜外粘连的组织学和超微结构研究. 中华骨科杂志, 1998, 18(5): 301-303.
13. 倪彬, 侯春林, 贾连顺, 等. 几丁质膜引导兔桡骨缺损骨再生的实验研究. 中华骨科杂志, 1995, 15(9): 607-609.
14. Keskin F, Esen H. Comparison of the effects of an adhesion barrier and chitin on experimental epidural fibrosis. Turk Neurosurg, 2010, 20(4): 457-463.
15. Jacobs RR, McClain O, Neff J. Control of postlaminectomy scar formation. An experimental and clinical study. Spine (Phila Pa 1976), 1980, 5(3): 223-229.
16. Lladó A, Sologaistua E, Guimerá J, et al. Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: a clinical study. Eur Spine J, 1999, 8(2): 144-150.
17. Wang J, Chen W, Li Y, et al. Biological evaluation of biphasic calcium phosphate ceramic vertebral laminae. Biomaterials, 1998, 19(15): 1387-1392.
18. 李玉宝. 纳米生物医药材料. 北京: 化学工业出版社, 2004: 36-40．.
19. 唐文胜, 蒋电明, 安洪, 等. 纳米羟基磷灰石/聚酰胺复合人工椎板预防脊柱后路术后椎管内瘢痕粘连的实验研究. 中国脊柱脊髓杂志, 2005, 15(11): 675- 678.
20. 蒋电明, 权正学, 黄伟, 等. 纳米羟基磷灰石/聚酰胺66复合生物活性人工椎板的初步临床应用. 中国修复重建外科杂志, 2007, 21(5): 441-444.
21. 周春光, 宋跃明, 屠重棋, 等. 可降解多元氨基酸共聚物/磷酸钙复合材料椎间融合器植入山羊颈椎即刻稳定性的生物力学评价. 生物医学工程学杂志, 2011, 28(1): 63-66.
22. Yu C, Kohn J. Tyrosine-PEG-derived poly (ether carbonate)s as new biomaterials. Biomaterials, 1999, 20(3): 253-264.
23. Rokkanen PU, Bostman O, Hirvensalo E, et al. Bioabsorbable fixation in orthopaedic surgery and traumatology. Biomaterials, 2002, 21(24): 2607-2613.
24. Wei J, Li YB, Chen WQ, et al. A study on nano-composite of hydroxyapatite and polyamide. J Mater Sci, 2003, 38(15): 3303-3306．.
25. Gupta HS, Seto J, Wagermaier W, et al. Cooperative deformation of mineral and collagen in bone at the nanoscale. Proc Natl Acad Sci U S A, 2006, 103(47): 17741-17746.
26. Urist MR, Mclean FC. Recent advances in physiology of bone. J Bone Joint Surg (Am), 1963, 45: 1305-1313.
27. Caroli E, Orlando ER, D’Andrea G, et al. Anterior cervical fusion with interbody titanium cage containing surgical bone site graft: our institution’s experience in 103 consecutive cases of degenerative spondylosis. Spinal Disord Tech, 2007, 20(3): 216-220.

Chinese Journal of Reparative and Reconstructive Surgery

NOVEL ARTIFICIAL LAMINA FOR PREVENTION OF EPIDURAL ADHESIONS AFTER POSTERIOR CERVICAL LAMINECTOMY

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