Prevention of epidural fibrosis with ADCON®-L in presence of a durotomy during lumbar disc surgery:: Experiences with a pre-clinical model

A potential complication of lumbo-sacral surgery is the inadvertent tear of the dura mater, which sometimes eludes intra-operative detection. ADCON(R)-L, a bioabsorbable gel used in lumbosacral laminectomies or laminotomies, is a physical barrier to post-operative epidural fibrosis. Three experimental lumbar laminectomy studies were designed to assess in vivo the effects of ADCON(R)-L when applied in presence of dural punctures in a rat model. In the first study, the durotomy was repaired with fibrin sealant, in the second experiment the dural defect was microsurgically sutured, while in a third protocol the durotomy was left unrepaired. In each study, dural healing was assessed respectively at 4, 8, or 12 weeks postoperatively. Blinded anatomical dissection and histopathology were used to compare results between treatments (sham operated control vs. ADCON(R)-L). In the fibrin sealant experiment, an additional treatment group (fibrin sealant used together with ADCON(R)-L) was included. The results of these studies consistently demonstrate that ADCON(R)-L is an effective anti-fibrotic agent, and does not interfere with the normal dural healing processes following a meningeal puncture. The application of the gel may therefore be safe in presence of dural incisions, even when they are not identified during surgery, as demonstrated in these in vivo studies.