Role of a collagen membrane in adhesion prevention strategy for complex spinal surgeries.

PURPOSE

Following lumbar spine surgery, postoperative complications can appear, including epidural adhesions. The formation of fibrosis around the dura mater can, on the one hand, lead to compression of the nerve roots with recurrent radicular pain and, on the other hand, can increase the risks of specific complications at spinal re-intervention (haematomas and dural breaches). The aim of this prospective monocentric study was to assess the safety of a new collagen antiadhesion membrane in vertebral osteotomy surgery where scar tissue and adhesions are important.

METHODS

Twenty-six patients consecutively operated for lumbar posterior subtraction osteotomy with implantation of a collagen-based anti-adhesion membrane were evaluated. Membrane tolerance was evaluated at the short and midterm during the regular follow-up.

RESULTS

At six months' follow-up, postoperative pain [visual analogue scale (VAS)] and disability (Oswestry Disability Index score) were significantly reduced 33.1 and 43.1%, respectively. These results were confirmed at 12-months' follow-up, with a decrease in pain of 39.9% and in disability of 49.3%. Amongst the observed postoperative complications was neither spinal fluid leak nor durotomy. Presence of the membrane was not related to complications. Two patients required further surgery for infection and nonunion at the osteotomised level. Adhesions to the dura mater were limited and thin, facilitating exposure.

CONCLUSIONS

This study shows good tolerance of the collagen based membrane for spinal osteotomy and its satisfactory use for preventing postoperative epidural adhesions. Good surgical practice associated with an anti-adhesion barrier may decrease fibrosis formation and improve postoperative functional results.