Prevention Of Epidural Adhesion After Laminectomy By The Use Of EPTFE Combined With FS

One of the most common complications of lumbar spine surgery is peridural fibrosis, a fibroblastic invasion of the nerve roots and the peridural sac exposed at operation. Peridural fibrosis may produce symptoms similar to those the patient experienced preoperatively and, if another spinal operation is necessary, may increase the risk of injury at reexposure. Peridural scarring causes tethering of dura and nerve roots. So peridural fibrosis after lumbar laminectomy and discectomy has been implicated as one of the factors that contribute to continuing or recurrent radicular low back pain. Peridural scarring causes tethering of dura and nerve roots. La Rocca ,et al thought that the peridural fibrosis came from the dorsal surface of the laminectomy defect, Songer(1990), et al thought that not only the peridural fibrosis came from the dorsal surface of the laminectomy defect, but also from fibroblastic invasion and complete enclosure of the nerve roots and dura. They refered to the three dimension theory that lead to the peridural fibrosis. There were many measure and materials to be test in order to Prevention of post-laminectomy membrane formation.Objective: To observe the effect of ePTFE (expanded polytetrafluoroethylene) combined with FS fibrin sealant in the prevention of fibrous scar formation in the epidural space after laminectomy. Method: According to the scheme of Latin square design, wide laminectomv was performed at four section, At the same time the exposed duras were covered with nothing (group A ) , FS (group B), ePTFE (group C),and ePTFE+FS (group D) respectively. Gross score , biochimical , histological and MRI evaluation of the vertebral laminae involved were carried out at four weeks postoperatively, Result: In The control group, thich fibrous connective tissue was observed. and there was no interspace between the dura and the scar, FS group (group B)was bad to prevent the scar, ePTFE group (group C) was superior to that of group A and B,But was bad to that of group D. In the ePTFE group, there was only a few epidurar scar scattering around the duar, and interspace could be found between the dura and the scar. Conclusion: Use ePTFE cooperated with FS has a better effect on prevention of peridural adhesion afterlaminectomv than use of ePTFE or FS alone.