Dehydrated human amnion/chorion membrane allograft for preventing epidural fibrosis after laminectomy: an experimental rat model

Year 2020, Volume: 6 Issue: 6, 534 - 538, 04.11.2020

Özhan Merzuk Uçkun , Denizhan Divanlıoğlu Rıfat Akdağ , Güner Menekşe , Ali Dalgıç , Ahmet Deniz Belen

https://doi.org/10.18621/eurj.523854

Cited By: 1

Abstract

Objectives:
Post-laminectomy
syndrome due to epidural fibrosis (EF) is a common cause of persistent low back
pain after lumbar spinal surgery and is challenging for both surgeons and
patients. The current experimental study aimed to investigate the effect of
dehydrated human amnion/chorion membrane (dHACM) allograft for preventing EF
formation following lumbar laminectomy.

Methods: Sixteen Sprague–Dawley rats equally divided into two
groups underwent lumbar laminectomy. Group A, the control group, underwent
lumbar laminectomy with standard closure. Group B, the experimental group,
additionally received epidural dHACM allografts during the procedure. After 45
days of follow-up, the rats were sacrificed, and the harvested tissues were
histopathologically evaluated for EF.

Results: Compared with Group A, Group B showed significantly
less EF generation (p < 0.001),
implying that dHACM allografts effectively prevent EF.

Conclusions: This study demonstrated that dHACM can effectively
reduce EF formation after spinal laminectomy in rats.

Keywords

Epidural fibrosis, laminectomy, amnion membrane allograft

References

• 1. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB. Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res 1981:191-9.
• 2. Fager CA, Freidberg SR. Analysis of failures and poor results of lumbar spine surgery. Spine (Phila Pa 1976) 1980;5:87-94.
• 3. North RB, Campbell JN, James CS, Conover-Walker MK, Wang H, Piantadosi S, et al. Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation. Neurosurgery 1991;28:685-90; discussion 690-81.
• 4. Ross JS, Robertson JT, Frederickson RC, Petrie JL, Obuchowski N, Modic MT, et al. Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. ADCON-L European Study Group. Neurosurgery 1996;38:855-61; discussion 861-53.
• 5. Tao H, Fan H. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J 2009;18:1202-12.
• 6. Einhaus SL, Robertson JT, Dohan FC, Jr, Wujek JR, Ahmad S. Reduction of peridural fibrosis after lumbar laminotomy and discectomy in dogs by a resorbable gel (ADCON-L). Spine 1997;22:1440-6; discussion 1446-7.
• 7. Gill GG, Scheck M, Kelley ET, Rodrigo JJ. Pedicle fat grafts for the prevention of scar in low-back surgery. Spine 1985;10:662-7.
• 8. 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 1993;79:89-95.
• 9. Wujek JR, Ahmad S, Harel A, Maier KH, Roufa D, Silver J. A carbohydrate polymer that effectively prevents epidural fibrosis at laminectomy sites in the rat. Exp Neurol 1991;114:237-45.
• 10. Laurent GJ, Chambers RC, Hill MR, McAnulty RJ. Regulation of matrix turnover: fibroblasts, forces, factors and fibrosis. Biochem Soc Trans 2007;35:647-51.
• 11. Boudreau N, Werb Z, Bissell MJ. Suppression of apoptosis by basement membrane requires three-dimensional tissue organization and withdrawal from the cell cycle. Proc Natl Acad Sci U S A 1996;93:3509-13.
• 12. Dua HS, Azuara-Blanco A. Amniotic membrane transplantation. Br J Ophthalmol 1999;83:748-52.
• 13. von Versen-Höynck F, Syring C, Bachmann S, Möller DE. The influence of different preservation and sterilisation steps on the histological properties of amnion allografts--light and scanning electron microscopic studies. Cell Tissue Bank 2004;5:45-56.
• 14. Koob TJ, Rennert R, Zabek N, Massee M, Lim JJ, Temenoff JS, et al. Biological properties of dehydrated human amnion/chorion composite graft: implications for chronic wound healing. Int Wound J 2013;10:493-500.
• 15. He Y, Revel M, Loty B. A quantitative model of post-laminectomy scar formation. Effects of a nonsteroidal anti-inflammatory drug. Spine Phila Pa 1976 1995;20:557-63; discussion 579-80.
• 16. Sant'Anna LB, Brito FS, Barja PR, Nicodemo MC. Long-term effects of human amniotic membrane in a rat model of biliary fibrosis. Braz J Med Biol Res 2017;50:e5692.
• 17. Dobran, M., D. Brancorsini, M. D. Costanza, V. Liverotti, F. Mancini, D. Nasi, M. Iacoangeli, and M. Scerrati: Epidural scarring after lumbar disc surgery: Equivalent scarring with/without free autologous fat grafts. Surg Neurol Int 2017;8:169.
• 18. Adds PJ, Hunt CJ, Dart JK. Amniotic membrane grafts, "fresh" or frozen? A clinical and in vitro comparison. Br J Ophthalmol 2001;85:905-7.
• 19. Choi HJ, Kim KB, Kwon YM. Effect of amniotic membrane to reduce postlaminectomy epidural adhesion on a rat model. J Korean Neurosurg Soc 2011;49:323-8.
• 20. Subach BR, Copay AG. The use of a dehydrated amnion/chorion membrane allograft in patients who subsequently undergo reexploration after posterior lumbar instrumentation. Adv Orthop 2015;2015:501202.
• 21. Kara D, Senol N, Kapucuoglu FN, Tureyen K. Effectiveness of human amniotic fluid and amniotic membrane in preventing spinal epidural fibrosis in an experimental rat model. J Neurol Sci 2015;32:293-302.