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.