Spine and Neurosurgery

Surgical Intervention

• Patient underwent a lateral interbody fusion at L3-L4 and L4-L5 and a laminectomy L3-L5 to achieve a decompression.
• Prior to closure, a 4 cm x 6 cm AMNIOFIX sheet was cut lengthwise into two pieces.
• The first 2 cm x 6 cm AMNIOFIX sheet was applied to the exposed dura and tucked underneath the lamina and lateral recesses.
• The second 2 cm x 6 cm AMNIOFIX sheet was applied on the cranial aspect of the exposed dura. The allograft was then tucked into the lateral gutters and underneath the cephalad lamina.

Goal

AMNIOFIX utilized to provide a protective barrier to support the healing cascade.

Conclusion

• The dura was decompressed and no postop complications were reported. The surgeon and patient were pleased with the outcome.
• The surgeon anticipated that this patient will likely have adjacent level disease to the treated area that would be symptomatic in 5 to 10 years and may require an adjacent level decompression.

ABSTRACT

Background Context: Products that can reduce development of epidural fibrosis may reduce risk for ongoing pain associated with development of [fibrotic] tissue and make subsequent epidural reexploration easier.

Purpose: To evaluate the use of Dehydrated Human Amnion/Chorion Membrane (DHACM) on the formation of soft tissue [fibrosis] in the epidural space.

Study Design: Case series.

Patient Sample: Five patients having transforaminal lumbar interbody lumbar fusion (TLIF) with posterior instrumentation and implantation of DHACM in the epidural space and subsequent epidural reexploration.

Outcome Measures: Degree of [fibrotic] tissue adjacent to the epidural space at reexploration. Intraoperative     and postoperative complications related to DHACM and patient reported outcomes.

Methods: [Reoperation was performed after] “radiological studies had been performed to document adequate fusion, as evidenced by bridging bone within the interbody space and adjacent intertransverse region.” The degree of fibrotic tissue adjacent to the epidural space was assessed during the reexploration surgery. Patients’ outcomes were collected using standard validated questionnaires.

Results: Four of 5 cases had easily detachable tissue during epidural reexploration. Angiolipoma of 10% was noted in 1 case and 5% in 2 cases. Significant improvements in patient reported outcomes were observed. No intraoperative or postoperative complications occurred.

Conclusions: Our findings suggest that DHACM implant during TLIF may have favorable effects on epidural fibrosis and is well-tolerated. Further studies with larger cohorts are required to prove our results.

HIGHLIGHTED RESULTS:

Craniotomy for Tumor Resection and Application of AMNIOEFFECT⁹

Clinical Background

59-year-old male presented with significant right sided upper extremity weakness and aphasia. MRI showed a large left sided mass causing symptoms and concerning malignancy.

Comorbidities

25-year history of smoking half a pack or more a day and hypertension.

Surgical Intervention

• Craniotomy was performed, tumor resected, and chemo wafers placed in resection cavity.
• 6 cm x 16 cm AMNIOEFFECT sheet placed on brain. Surgeon was very satisfied with the ease of handling of the product, the ability to visualize it, and that it stayed in place while using suction.
• Bone flap screwed into place with metal plating system.
• Multi-layer tissue closure on the skull.

Goal

AMNIOEFFECT utilized to provide a protective barrier to support the healing cascade.

Follow Up

• Approximately two weeks postop, cranial incision staples removed.
• Incision was intact and closed.
• Patient had improvement of both his right upper extremity strength and speech.

6 cm x 16 cm AMNIOEFFECT sheet placed on brain.