The use of expanded polytetrafluoroethylene as an interpositional membrane after lumbar laminectomy.
METHODS
Prevention of post-laminectomy membrane formation was evaluated in a canine model. Fat graft, Silastic sheeting and expanded polytetrafluoroethylene were compared with nonimplanted control sites.


OBJECTIVE
The development of an effective barrier to peridural scar invasion is of major importance in optimizing results after lumbar laminectomy.


BACKGROUND
Postoperative peridural fibrosis represents a normal biologic response after lumbar spinal surgery. A variety of biologic and nonbiologic interpositional materials have been studied. Expanded polytetrafluoroethylene has been shown to limit scar adhesion in the pericardium and peritoneum and has not been studied previously as a postlaminectomy interpositional membrane.


METHODS
Eleven adult female cross-bred hounds underwent multilevel standardized laminotomies. Three materials--fat graft, Silastic sheeting, and expanded polytetrafluoroethylene--were compared with nonimplanted controls. The animals were killed 12 weeks after surgery and were evaluated histologically and using gadolinium-enhanced magnetic resonance imaging.


RESULTS
The magnetic resonance imaging studies were inconclusive in assessing peridural scar extension or identifying the implanted membranes. Histology revealed dense scar tissue at all control sites and replacement of all fat grafts by scar. Scar density was significantly less for the expanded polytetrafluoroethylene membrane surgical sites than for the control, fat graft, and Silastic sheeting sites.


CONCLUSIONS
Expanded polytetrafluoroethylene membrane is biocompatible, maintains its structural integrity, and is impervious to fibrous ingrowth. These findings support further investigation of expanded polytetrafluoroethylene membrane as an interpositional material to prevent post-laminectomy peridural fibrosis.
DiFazio
F A
FA
Department of Orthopaedics and Rehabilitation, University of Vermont, College of Medicine, Burlington, USA.
Nichols
J B
JB
Pope
M H
MH
Frymoyer
J W
JW
D000273:Adipose Tissue / Q000637:transplantation; D000818:Animals; D002921:Cicatrix / Q000473:pathology / Q000517:prevention & control*; D004285:Dogs; D004388:Dura Mater / Q000473:pathology*; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000517:prevention & control*; D019736:Prostheses and Implants; D012826:Silicone Elastomers; D013116:Spinal Cord / Q000473:pathology
D012826:Silicone Elastomers; D011138:Polytetrafluoroethylene