Comparison of a caprolactone/lactide film (mesofol) to two polylactide film products as a barrier to postoperative peridural adhesion in an ovine dorsal laminectomy model

Polycaprolactone/Polylactic Acid Membrane Fails to Prevent Laminectomy-induced Sprouting of CGRP- and SP-immunopositive Nerve Fibres in the Dura mater lumbalis of Rats

BACKGROUND CONTEXT

Mechanisms and prevention of failed back surgery syndromes are rarely known in the clinical context. It has been shown that laminectomy induces outgrowth of putative nociceptive peptidergic afferents in the dura mater lumbalis of rats.

PURPOSE

We aimed to investigate whether the application of a polycaprolactone/polylactic acid membrane (Mesofol) after surgery inhibits sensory hyperinnervation.

MATERIALS/METHODS

Adult Lewis rats were assigned to three groups: Control (no manipulation), Laminectomy and Laminectomy + Mesofol. Six weeks post-surgery, the durae were removed, immunohistochemically stained for CGRP- and SP-positive afferents and their density quantified.

RESULTS

In controls, CGRP- and SP-positive neurons were predominantly found in ventral but rarely observed in dorsal parts of the dura. Following laminectomy, the density of afferents significantly increased ventrally, resulting in a dense network of nerve fibers. In dorsal regions, neuronal sprouting of was observed. Covering the dura with Mesofol after laminectomy had no impact on nerve fibre outgrowth.

CONCLUSION

Application of Mesofol neither prevents nor significantly diminishes the laminectomy-induced increase in the density of peptidergic afferents.

A double-layer dura mater based on poly(caprolactone-co-lactide) film and polyurethane sponge: preparation, characterization, and biodegradation study

Synthetic, biodegradable polymers hold great potential in dura mater substitution. In this study, a dura mater-mimetic double-layer film@sponge composite was developed. The composite contains a poly(caprolactone-co-lactide) (PCLA) film and polyurethane (PU) sponge, which simulates the hard and soft layers of dura mater, respectively. PCLA films were prepared by a solution-casting method and showed excellent mechanical properties and tolerance to water. PU sponge was hydrophilic and had a high water-absorption rate (about 500%). The double-layer composite (film@sponge) integrated the good mechanical properties of the films and the good water absorption of the sponge. The excellent biocompatibility and biodegradability of the PCLA film@PU sponge composites were verified by in vitro degradation and cytotoxicity study and the in vivo implantation in the back of rats. Importantly, the film@sponge composite had a suitable degradation rate and good biocompatibility, holding potential in the field of dural repair.

An investigational study of a dual-layer, chorion-free amnion patch as a protective barrier following lumbar laminectomy in a sheep model

The inherent properties of the human amniotic membrane (HAM) suggest its potential for use as a physical barrier during surgery to protect neural elements and vessels from the surrounding environment. The objective of this study was to evaluate the effect of a dual-layer, chorion-free amnion patch (DLAM; ViaShield®, Globus Medical Inc., Audubon, PA, USA) processed from HAM as a protective barrier following lumbar laminectomy in a sheep model. A multiplex immunoassay was performed to quantify the inherent cytokines present in the amnion after processing. Twelve skeletally mature female crossbred Suffolk sheep were randomly divided into two equal post-operative periods (4 and 10 weeks). Each sheep underwent a laminectomy at L3 and L5, and one of the surgical sites randomly received the DLAM treatment. At each postsurgical time point, the extent of epidural fibrosis and neurohistopathological responses at the laminectomy sites was assessed based on epidural fibrosis-dura tenacity scores and decalcified histology, respectively. Immunoassay results showed that inflammatory mediators and immunomodulatory cytokines were present in the amnion after processing, but no proangiogenic cytokines were detected. At 10 weeks, tissue tenacity was significantly less in the DLAM treatment group when compared with the operative control (1.2 ± 0.4 vs. 2.8 ± 0.4, p < 0.05), demonstrating the ability of DLAM to act as a barrier and cover the dura. Gross observations showed fewer fibroblasts in the DLAM group in comparison with the control at both post-operative time points. Fibroblast infiltration analysis indicated that at both 4 and 10 weeks, there were significantly more infiltrated fibroblasts in the operative control sites than in the DLAM-treated sites, expressed as a percentage of the total number of fibroblasts present (4 weeks: 72.3 ± 10.2% vs. 10.8 ± 10.1%, p < .05; 10 weeks: 84.9 ± 15.8% vs. 43.1 ± 11.6%, p < .05). Additionally, fibroblasts travelled further into the dura in the operative control group compared with the DLAM-treated group at both time points. In conclusion, this study found that DLAM reduced fibroblast infiltration and tissue tenacity following lumbar laminectomy in a sheep animal model. These findings support the potential use of DLAM in clinical practice as a protective barrier for neural elements and anterior vessels.

The effects of bi-functional anti-adhesion scaffolds on flexor tendon healing in a rabbit model

Progressive tendon adhesion is a major challenge in flexor tendon repair. The authors developed a bifunctional anti-adhesion scaffold and hypothesized that its application would reduce adhesion formation and deliver mesenchymal stem cells (MSCs) to enhance tendon healing. The scaffold was fabricated by an electrospinning machine before surface modification. The flexor tendons of 29 New Zealand rabbits underwent surgical repair and randomized to control, scaffold and scaffold loaded with MSC group. At 3 and 8 weeks post-surgery, range of motion (ROM), biomechanical properties, and histology were examined. There was no significant increase in ROM and biomechanical properties between the three groups. The histology showed successful delivery of MSCs but no significant difference in nuclear morphometry. This barrier delivers and retains MSCs within the tendon repair site. However, its sheet form and wrapping around the repair site may not be optimal for tendon healing. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2605-2614, 2018.

Polymer materials for prevention of postoperative adhesion

Postoperative adhesion (POA) is a common complication that often occurs after a variety of surgeries, such as plastic surgery, repair operations of abdominal, pelvic, and tendon, and so forth. Moreover, POA leads to chronic abdominal pain, secondary infertility in women, intestinal obstruction, and other severe complications, which significantly reduce the life quality of patients. In order to prevent the formation of POA, a number of strategies have been developed, among which an emerging method is physical barriers consisting of polymer materials. This review highlights the most commonly used natural and synthetic polymer materials in anti-adhesion physical barriers. The specific features of polymer materials are analyzed and compared, and the possible prospect is also predicted.

STATEMENT OF SIGNIFICANCE

Postoperative adhesion (POA) is a serious complication accompanied with various surgeries. Polymer material-based physical barriers have attracted a large amount of attention in POA prevention. The polymer barriers can effectively avoid the formation of fibrous tissues among normal organs by reducing the interconnection of injured tissues. In this review, specific features of the natural and synthetic polymer materials for application in POA prevention were presented, and the possible prospects were predicted. All in all, our work can provide inspiration for researchers to choose proper polymer materials for preclinical and even clinical anti-adhesion studies.

Synthesis, properties and biomedical applications of hydrolytically degradable materials based on aliphatic polyesters and polycarbonates

Polyester-based polymers represent excellent candidates in synthetic biodegradable and bioabsorbable materials for medical applications owing to their tailorable properties. The use of synthetic polyesters as biomaterials offers a unique control of morphology, mechanical properties and degradation profile through monomer selection, polymer composition (i.e. copolymer vs. homopolymer, stereocomplexation etc.) and molecular weight. Within this review, the synthetic routes, degradation modes and application of aliphatic polyester- and polycarbonate-based biomaterials are discussed.

NEW TECHNIQUE FOR REDUCING FIBROSIS IN RECURRENT CASES OF CARPAL TUNNEL SYNDROME

Purpose: Synthetic bio-degradable materials have been used as an artificial barrier in prophylaxis of adhesions. We report on the use of lactid caprolacton film (Mesofol®) in recurrent carpal tunnel syndrome. We hypothesise that its use will give favourable results regarding the functional outcome and the recurrence rate.

Patients and methods: Fourteen patients were prospectively reviewed following neurolysis and application of Mesofol® film. Average age was 48 years. Outcome assessment measures included; two-point discrimination, verbal rating scale, and Boston Questionnaire.

Results: Follow-up period averaged 25.5 months. Post-operative two-point discrimination improved to an average of 4.57 mm. The post-operative average verbal rating scale was 1.5. The mean symptom severity score improved to 1.88 and the mean functional score improved to 1.69 post-operatively.

Conclusion: In cases of recurrent carpal tunnel syndrome, the use of mesofol barrier yields good functional results at the short term follow-up. The technique is simple. No patients needed further surgeries.

Induction of myogenic differentiation of human mesenchymal stem cells cultured on Notch agonist (Jagged-1) modified biodegradable scaffold surface

Engineered scaffold surface provides stem cells with vital cues that could determine the eventual fate of stem cells. In this work, biodegradable poly(L-lactide-co-ε-caprolactone) (PLCL) scaffold conjugated with Notch agonist-Jagged-1(JAG) peptide (2.1 kDa) was prepared to initiate myogenic differentiation of human mesenchymal stem cells (hMSCs). The scaffold surface was activated with oxygen plasma and acrylic acid was engrafted via UV polymerization to form a surface bearing carboxylic groups. JAG peptide was subsequently immobilized onto the carboxylated scaffold surface. Surface chemistry and topography were examined using attenuated total reflection Fourier transform infrared, X-ray photoelectron spectroscopy, and atomic force microscopy. Quantitative real time polymerase chain reaction analysis revealed activation of the Notch pathway; furthermore, several specific markers associated with myogenic but not osteogenic differentiation were shown to be up-regulated in hMSCs cultured on the engineered surface. The pro-myocardial effect of surface bound JAG peptide was further affirmed via immunodetection of the distinct myocardial marker, cardiac troponin T. Collectively, our results suggest that PLCL conjugated JAG peptide is a viable strategy to enhance the functional potential of scaffolds to be used as a bioengineered cardiac patch in myocardial infarction repair.

Magnetic resonance imaging (MRI) anatomy of the ovine lumbar spine

Although the ovine spine is a useful research model for intervertebral disc pathology and vertebral surgery, there is little peer-reviewed information regarding the MRI anatomy of the ovine spine. To describe the lumbar spine MRI anatomy, 10 lumbar segments of cadaver ewes were imaged by 1.5-Tesla MR. Sagittal and transverse sequences were performed in T1 and T2 weighting (T1W, T2W), and the images were compared to gross anatomic sagittal and transverse sections performed through frozen spines. MRI was able to define most anatomic structures of the ovine spine in a similar way as can be imaged in humans. In both T1W and T2W, the signals of ovine IVDs were similar to those observed in humans. Salient anatomic features were identified: (1) a 2- to 3-mm linear zone of hypersignal was noticed on both extremities of the vertebral body parallel to the vertebral plates in sagittal planes; (2) the tendon of the crura of the diaphragm appeared as a hypointense circular structure between hypaxial muscles and the aorta and caudal vena cava; (3) dorsal and ventral longitudinal ligaments and ligamentum flavum were poorly imaged; (4) no ilio-lumbar ligament was present; (5) the spinal cord ended between S1-S2 level, and the peripheral white matter and central grey matter were easily distinguished on T1W and T2W images. This study provides useful reference images to researchers working with ovine models.

Safety and effectiveness of a polyvinyl alcohol barrier in reducing risks of vascular tissue damage during anterior spinal revision surgery

STUDY DESIGN

This study was conducted as a controlled, prospective investigation to show the safety and efficacy of a polyvinyl alcohol (PVA) device in a sheep model.

OBJECTIVE

To evaluate the ability of a permanent PVA hydrogel barrier to reduce the risk of potential vessel damage during anterior vertebral revision surgery, to provide a nonadhesive barrier at the surgical site, and to create a surgical revision plane of dissection.

BACKGROUND

The development of scar tissue and adhesions presents a significant postoperative problem in spine surgery, where adhesion involvement of overlying structures can cause pain, neurovascular complications, and present a difficult surgical environment during revisions.

METHODS

The devices were implanted onto the ventral surface of exposed lumbar intervertebral discs using an anterolateral approach. One disc separated from the study site was also exposed to serve as a control. Three sheep each were then evaluated with an explant procedure at 30 and 90 days. Extensive sampling was undertaken to evaluate gross anatomic, micropathologic, and biochemical environments and properties of the device.

RESULTS

The structural properties and appearance of the device remained intact at both 30 and 90 days. The material remained flexible, hydrophilic, and soft, without visible resorption or decomposition. The material was well tolerated by the animal, with minimal histologic signs of inflammation or rejection. Tissue planes were easily able to be localized by the surgeon attempting to locate the prior surgical site at the time of resection.

CONCLUSIONS

The PVA vessel shield effectively protected the structures overlying the sheep spine during revision, providing a clear dissection plane for resection at repeat surgery. The overlying structures separated from the previous surgical site with no adhesion, and allowed safe separation of adjacent tissues without the use of sharp dissection.

Dura mater regeneration with a novel synthetic, bilayered nanofibrous dural substitute: an experimental study

Aim: To create a synthetic nanofibrous dural substitute that overcomes the limitations of current devices by enhancing dural healing via biomimetic nanoscale architecture and supporting both onlaid and sutured implantation. Materials & methods: A custom electrospinning process was used to create a bilayer dural substitute having aligned nanofibers on one side and random nanofibers on the other. Nanoscale architecture was verified using microscopy and macroscale mechanical properties were investigated using tensile testing. Biological response to this device was investigated both in vitro and in a canine duraplasty model. Results & conclusion: Bilayer nanofiber alignment yields a graft having anisotropic mechanical properties with significantly higher strength and suturability than a commercially available collagen matrix. When implanted, the nanofibrous graft prevents leaks and brain tissue adhesions, and encourages dura mater regrowth, performing comparably to the collagen matrix. Both in vitro fibroblast orientation and in vivo dural healing are enhanced by the aligned nanofibers.

Development of complete thoracic spinal cord transection model in rats for delayed transplantation of stem cells

STUDY DESIGN

In vivo study of a rat spinal cord injury model.

OBJECTIVES

To develop complete transection model of thoracic spinal cord using a polymer sheet and a microtube relevant for delayed transplantation of stem cells.

SUMMARY OF BACKGROUND DATA

Stem cell transplantation for the regeneration of spinal cord injuries has used animal models. However, current models suffer from inflammation and leakage, which lessens their usefulness in studying delayed stem cell transplantation.

METHODS

Thoracic spinal cord at T9 level of adult Sprague-Dawley rats was exposed and a 50:50 sheet of poly(D,L-lactic-coglycolic acid) was inserted, exposed spinal cord was completely transected, and collagen was filled between the gap between the proximal and distal stumps of transected spinal cord. A microtube was placed and fixed between the polymer surfaces facing each other. Behavior testing, magnetic resonance imaging, and myelography were performed to characterize the new complete transection with a gap formation and polymer insertion (GAP) model and to compare the GAP model with the control models. Human mesenchymal stem cells (hMSCs) were transplanted into 3 models and immunohistochemistry and western blot were performed.

RESULTS

The inserted poly(D,L-lactic-coglycolic acid) sheet was completely disappeared 10 weeks after operation, but the inserted microtube remained firmly fixed in its original position. Myelography of the GAP model showed no leakage of contrast medium around the injured spinal cord, whereas magnetic resonance imaging of the severe contusion and simple transection models showed some leakage of contrast medium. Immunohistochemistry and western blot after hMSCs transplantation indicated that transplanted hMSCs survived and migrated well in the GAP model, and the deposition of inflammatory cells in GAP model was less than a simple transection model or severe contusion model.

CONCLUSION

The developed GAP model is more relevant for delayed transplantation of stem cells for the study of regeneration of spinal cord injury of rats.

Reduction in postlaminectomy epidural adhesions in sheep using a fibrin sealant-based medicated adhesion barrier

Epidural adhesion formation is believed to be a central governing factor in the prevalence of pain after spinal surgery and is regarded as being the primary instigator of neural tethering, leading to complications during revision surgery. In this study, we assess the effectiveness and safety of fibrin sealant supplemented with tributyrin, termed Medicated Adhesion Barrier (MAB), as an alternative means of reducing the incidence of posterior spinal epidural adhesion formation. Laminectomy defects in sheep were treated with MAB, fibrin sealant alone, ADCONGel, or remained untreated. At 12 weeks postoperatively, the extent of fibrosis and epidural adhesion formation was evaluated using magnetic resonance imaging (MRI), peel-off testing, and histological examination. Initial invitro analysis revealed that tributyrin was retained in fibrin gel in a time-dependent manner and was an effective inhibitor of fibroblast proliferation. Treatment of sheep with MAB significantly reduced both the prevalence (p < 0.05) and tenacity (p < 0.05) of epidural adhesions. The effectiveness of MAB in preventing epidural adhesions was found to be comparable with that of ADCONGel. No adverse events were reported after the use of MAB. The MAB preparation seems to be an effective resorbable barrier for the prevention of epidural adhesions.

Biodegradable inflatable balloon for reducing radiation adverse effects in prostate cancer

Carcinoma of the prostate is one of the most abundant killers for men in the western world, and it is frequently treated via Radiation therapy. Unfortunately, radiotherapy side effects include rectal irritation and bleeding, erectile dysfunction and urinary frequency. Because radiation intensity decays rapidly as a function of distance, displacing irradiated prostate away from normal tissues would reduce damage and therefore side effects. The objective of this study is to develop an inflatable balloon that is implanted via a minimal invasive procedure. The balloon is made of a biodegradable polymer called poly(lactide-co-epsilon-caprolactone). The implant is inserted rolled throughout the perineum; inflated in situ with a physiological saline; sealed and placed between the rectum wall, and the prostate gland. Balloon's mechanical and chemical properties were extensively characterized both in vitro and in vivo. The balloon's preparation ensures no bonding across surfaces as these may endanger the implant mechanical stability. Moreover, the coating method does not alter the polymer's molecular weight and therefore preserve its mechanical properties. Balloon's sterilization was carried out using ethylene oxide which, as our results show and in comparison with gamma-irradiation, doesn't damage the mechanical stability of the implant. The proper functionality of the insertion-mounting device as well as the balloon capability to retain its inflated form during patients' radiation session was demonstrated both in vitro and in vivo.