Effect of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits.
OBJECTIVE
To determine the efficacy of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits.


METHODS
Twenty-four Japanese white rabbits underwent laminectomy (including the attached ligaments) at L(2 ) and L(5). After laminectomy at L(5), polylactic acid glue was sprayed on the dura and nerve roots and this segment was taken as the experimental group. After laminectomy at L(2), nothing was used and this segment was enrolled as the self control group. Four rabbits were killed every two weeks postoperatively till the end of the experiment at 12 weeks. Then the operated spine was observed grossly, histologically and ultrastructurally to check the degree of scar formation, the status of epidural scar adhesion, the absorption of the glue, and the intracellular structure of fibroblasts.


RESULTS
The glue coagulated immediately after spraying and showed excellent hemostatic effect. The glue membrane was easy to be taken away from the dura mater of the samples for 2 weeks and there were no cells in the epidural space in the experimental group. But the dura mater was covered by hematoma in the control group, which formed mild adhesion, with fibroblasts proliferating actively. In the 4th week, some glue shivers remained in the epidural space with fibroblasts increasing a little, and the dura mater was smooth in the experimental group. However, in the control group, the formed scar was fragile and conglutinated with the dura mater diffusely and fibroblasts were much more than those in the experimental group. In the 6th-12th weeks, there was a potential interspace between the scar and the dura mater, and the polylactic acid glue was absorbed completely in the experimental group. Much tough scar was found in the control group, which was very difficult to dissect from the dura mater and the surrounding tissues. From the ultrastructural observation of the fibroblasts, the nucleus became much bigger and the rough endoplasmic reticulum was much more plentiful in the control group than that in the experimental group.


CONCLUSIONS
Polylactic acid glue can effectively reduce epidural cicatrization and adhesion.
Liu
Li-min
LM
Department of Orthopedics, West China Hospital of Sichuan University, Chengdu 610041, China.
Song
Yue-ming
YM
Duan
Hong
H
Ding
Yong-li
YL
Lu
Bing
B
D000818:Animals; D001672:Biocompatible Materials; D002921:Cicatrix / Q000517:prevention & control*; D019344:Lactic Acid / Q000008:administration & dosage / Q000494:pharmacology*; D007796:Laminectomy; D008567:Membranes, Artificial; D011091:Polyesters; D011108:Polymers / Q000008:administration & dosage / Q000494:pharmacology*; D011183:Postoperative Complications / Q000517:prevention & control*; D011817:Rabbits; D000267:Tissue Adhesions / Q000517:prevention & control*
D001672:Biocompatible Materials; D008567:Membranes, Artificial; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)