Pospiech J, Pajonk F, Stolke D
Department of Neurological Surgery, University Hospital GHS Essen, Germany.
Eur Spine J. 1995;4(4):213-9. doi: 10.1007/BF00303413.
Extensive epidural scar formation is a well-known complication after spine surgery. Fibrous adhesions around nerve roots are a major reason for recurrent neurological symptoms following lumbar discectomy. A large variety of materials, implanted onto the dura, have been used to prevent or reduce laminectomy membrane, with conflicting results. We therefore carried out an experimental study in dogs to compare those materials that seemed to be most suitable. In each of 30 adult beagles, three lumbar laminectomies were performed. Each level was covered with a different material--free autologous fat graft, cellulose mesh, Gelfoam or triamcinolone suspension. In a control group nothing was implanted. After 7 days or 1, 3 or 6 months the animals were killed. The lumbar vertebral columns were harvested and prepared for further histological examination. To compare the results, we designed a new classification scheme (scar index). The data were obtained without knowledge of implanted material or time since operation. We found that free autologous fat grafts are able to reduce epidural scar formation in a high proportion of cases, especially after 3 and 6 months; cellulose mesh showed the worst results. We conclude that free autologous fat grafts are superior to other materials because of simple operative handling, good compatibility and effective prevention of laminectomy membrane.
广泛的硬膜外瘢痕形成是脊柱手术后一种众所周知的并发症。神经根周围的纤维粘连是腰椎间盘切除术后复发性神经症状的主要原因。为预防或减少椎板切除膜，人们在硬脊膜上植入了各种各样的材料，但结果相互矛盾。因此，我们在犬类身上进行了一项实验研究，以比较那些似乎最合适的材料。在30只成年比格犬中，每只都进行了三次腰椎椎板切除术。每个节段覆盖一种不同的材料——游离自体脂肪移植、纤维素网、明胶海绵或曲安奈德悬液。对照组不植入任何材料。在7天或1、3、6个月后处死动物。取出腰椎椎体进行进一步的组织学检查。为比较结果，我们设计了一种新的分类方案（瘢痕指数）。获取数据时不知道植入的材料或术后时间。我们发现，游离自体脂肪移植在很大比例的病例中能够减少硬膜外瘢痕形成，尤其是在3个月和6个月后；纤维素网的效果最差。我们得出结论，游离自体脂肪移植优于其他材料，因为其手术操作简单、兼容性好且能有效预防椎板切除膜。
