Application of microchannel technique in minimally invasive resection of cervical intraspinal tumors / 北京大学学报(医学版)

Objective:To explore the application and key points of microchannel approaches in resec-tion of cervical intraspinal tumors.Methods:A retrospective analysis was performed on 51 cases of cervi-cal spinal canal tumors from February 2017 to March 2020.Among them,5 cases were located epidural space,6 cases were located epidural and subdural space,and 40 cases were located under the subdural extramedullary space(6 cases were located on the ventral side of the spinal cord).The maximum diameter ranged from 0.5 to 3.0 cm.The clinical manifestations included neck,shoulder or upper limb pain 43 cases,sensory disturbance(numbness)in 22 cases,and limb weakness in 8 cases.The micro-channel keyhole technique was used to expose the tumor,and the tumor was resected microscopically.Results:In this study,35 patients underwent hemilaminectomy,12 patients underwent interlaminar fenestration,2 patients underwent medial 1/4 facetectomy on the basis of hemilaminectomy or interlaminar fenestration.Two tumors were resected through anatomy space(no bone was resected).The degree of tumor resection included total resection in 50 cases and subtotal resection in 1 case.The type of the tumor included 36 schwannomas,12 meningiomas,2 enterogenic cysts and 1 dermoid cyst.There was no infec-tion and cerebrospinal fluid leakage postoperatively.Limb numbness occurred in 7 patients.The average follow-up time was 15 months(3 to 36 months).No deformity such as cervical instability or kyphosis was found.The tumor had no recurrence.Conclusion:The cervical spinal canal is relatively wide,cervical tumors with no more than three segments can be fully exposed by means of microchannel technology.Besides intramedullary or malignant tumors,they can be microsurgically removed.Preservation of the skeletal muscle structure of cervical spine is beneficial to recover the anatomy and function of cervical spine.The electrophysiological monitoring helps to avoid spinal cord or nerve root injury.

Clinical effect of lumbar spinal stenosis withⅠ° spondylolisthesis without clinical instability by uniaxial PLUS endoscopic ULBD technique / 国际外科学杂志

Objective:To evaluate the efficacy of uniaxial PLUS endoscopic unilateral laminotomy for bilateral decompression (ULBD) technique in the treatment of lumbar spinal stenosis with Ⅰ° spondylolisthesis without clinical instability.Methods:A retrospective case analysis method was used to analyze the clinical data of 21 patients with lumbar spinal stenosis with Ⅰ° spondylolisthesis without clinical instability treated by uniaxial PLUS endoscopy via posterior ULBD technique in Shanxi Provincial People′s Hospital from May 2019 to May 2022. There were 10 males and 11 females, aged from 65 to 81 years, the average age was (69.00±3.62) years. The visual analogue scale (VAS), Oswestry disability index (ODI) and limp distance were evaluated before operation and at 3, 6 and 12 months after operation. The overall clinical efficacy was evaluated by MacNab score at 12 months after operation. Lumbar dynamic radiography was used to evaluate the stability of the lumbar spine before operation and at 3 months after operation. Measurement data were expressed as mean±standard deviation ( ± s), t-test was used for comparison before and after operation, and one-way repeated measures analysis of variance was used for comparison at different time points. Results:According to MacNab score, the results were excellent in 12 cases (57.1%), good in 6 cases (28.6%), fair in 2 cases(9.5%)and poor in 1 case(4.8%), the overall excellent and good rate was 85.7% (18/21). The VAS, ODI and limp distance at 3, 6 and 12 months after operation were significantly improved compared with those before operation, the differences were statistically significant ( P<0.01). There was no significant change in the stability of the lumbar spine dynamic position before and after operation. Conclusion:Uniaxial PLUS endoscopic ULBD technique can significantly improve the clinical efficacy in the treatment of lumbar spinal stenosis with Ⅰ° spondylolisthesis without clinical instability, and there is no significant change in stability after operation, and good clinical results can be achieved.

Effects of intravenous and topical tranexamic acid on blood loss and inflammatory response after posterior cervical decompressive laminectomy / 中国组织工程研究

BACKGROUND:With the increase of the incidence of cervical spondylosis,it is particularly important to control the postoperative bleeding and related inflammatory reaction of cervical vertebra. OBJECTIVE:A prospective study was conducted to investigate the combined effect of intravenous and topical tranexamic acid of different concentrations on postoperative blood loss and inflammatory response during posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion. METHODS:From January 2020 to December 2022,150 patients who were scheduled to undergo posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion for cervical spondylotic myelopathy in Tianjin People's Hospital were enrolled in the study.Patients were divided into A,B,and C groups(n=50)by randomized double-blind lottery.The patients in the A,B,and C groups were treated with 1%,3%,and 5%intravenous and topical tranexamic acid solution,respectively.Postoperative blood loss and inflammation-related indicators were compared among three groups.The occurrence of venous thromboembolism and hematoma was observed after operation. RESULTS AND CONCLUSION:(1)There were significant differences in blood loss-related indexes,such as intraoperative blood loss,overall blood loss,and occult blood loss among the three groups(P<0.01).The above indexes were significantly lower in groups B and C than that in group A.There was no significant difference between groups B and C(P>0.05).(2)On days 1 and 3 after surgery,the levels of inflammatory indicators including serum C-reactive protein and interleukin-6 were increased to varying degrees in the three groups compared to before surgery(P<0.05).As the drug concentration increased,its expression decreased,and there was a significant difference among the three groups(P<0.001).(3)Two cases of intramuscular venous thrombosis appeared in each of the three groups after surgery.No hematoma or pulmonary embolism occurred in all three groups.(4)It is concluded that in posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion,intravenous combined with topical application of different concentrations of tranexamic acid is effective in reducing perioperative blood loss and inflammatory response.3%tranexamic acid achieves the same effect without significantly increasing the risk of postoperative venous thromboembolism.

Application effect and safety analysis of unilateral laminectomy and bilateral decompression under unilateral biportal endoscopy and microendoscope in lumbar spinal stenosis / 中国内镜杂志

Objective To analyze the efficacy and safety of unilateral laminectomy and bilateral decompression under unilateral biportal endoscopy(UBE)and microendoscope(MED)in lumbar spinal stenosis.Methods 80 patients with lumbar spinal stenosis from January 2021 to December 2022 were selected and divided into two groups by numerical table method,the control group and the study group,and the number of cases was 40.The grouping method was random number table method.The control group was treated with unilateral laminectomy and bilateral decompression under MED,while the study group was treated with unilateral laminectomy and bilateral decompression under UBE.Operation time,intraoperative blood loss,Oswestry disability index(ODI)and visual analogue scale(VAS)of lumbago and leg pain were obtained before surgery,1,3 months after surgery and at the last follow-up,efficacy and complications were compared between the two groups.Result There were no significant differences in operative time and blood loss between the study group and the control group(P>0.05).1,3 months after surgery and at the last follow-up,ODI in both groups were lower than those before surgery(P<0.05),but there was no difference between the study group and the control group(P>0.05).The VAS of lumbago and leg pain in both groups were lower than those before surgery(P<0.05),at 1,3 months after surgery and the last follow-up,and the study group was significantly lower than the control group(P<0.05).The excellent and good rate of clinical treatment in the study group was 97.50%,and there was no difference compared with 92.50%in the control group(P>0.05).The complication rate of the study group was 2.50%,significantly lower than that of the control group(15.00%)(P<0.05).Conclusion Unilateral laminectomy and bilateral decompression under the UBE and MED have similar efficacy in the treatment of lumbar spinal stenosis,both of which can effectively promote functional recovery,but UBE can reduce pain more effectively and has fewer postoperative complications.

Multilevel spinal epidural empyema: series of clinical cases and bibliographic / Empiema epidural espinhal multinível: série de casos clínicos e revisão bibliográfica / Empiema epidural espinal multinivel: serie de casos clínicos y revisión bibliográfica

ABSTRACT: Multilevel spinal epidural empyema (SEE) is a rare and serious infection of the spine with a high rate of morbidity and mortality. Although abscesses or empyema of the spine sector are well studied, this pathology is surprising due to its rarity and diagnostic and therapeutic challenge. It stands out for being more common in adulthood and in males and is associated with predisposing pathologies. The bacteriological agent responsible in most cases is Staphylococcus aureus. Early treatment is essential and is based on two pillars: antibiotic therapy and decompressive surgery. We present two clinical cases with multilevel involvement that evolved favorably both infectiously and neurologically without causing spine instability and we carried out a bibliographic review of the subject. Level of Evidence IV; Case Report.

RESUMO: O empiema epidural espinhal multinível (EEE) e uma infecção rara e grave da coluna vertebral, com alta taxa de morbidade e mortalidade. Embora os abscessos ou empiemas de um setor da coluna vertebral sejam bem estudados, esta patologia surpreende pela sua raridade e desafio diagnóstico e terapêutico. Destaca-se por ser mais comum na idade adulta, no sexo masculino, e estar associada a patologias predisponentes. O agente bacteriológico responsável na maioria dos casos e o Staphylococcus aureus. O tratamento precoce e essencial e baseia-se em dois pilares: antibioticoterapia e cirurgia descompressiva. Apresentamos dois casos clínicos com envolvimento multinível que evoluíram favoravelmente tanto infecciosa quanto neurologicamente sem causar instabilidade da coluna vertebral e realizamos uma revisão bibliográfica do assunto. Nível de Evidencia IV; Estudo de Caso-controle.

RESUMEN: El empiema epidural espinal (EEE) multinivel es una infección rara y grave de la columna vertebral con alta tasa de morbimortalidad. Si bien los abscesos o empiemas de un sector de la columna están bien estudiados, esta patología sorprende por su rareza, reto diagnóstico y terapeutico. Se destaca por ser más frecuente en la edad adulta, en el sexo masculino y se ve asociada a patologías predisponentes. El agente bacteriológico responsable en la mayoría de los casos es el Staphylococcus aureus. El tratamiento precoz es fundamental y está basado en dos pilares: antibioticoterapia y quirúrgico descompresivo Presentamos dos casos clínicos con afectación multinivel que evolucionaron favorablemente tanto en lo infeccioso como en lo neurológico sin provocar una inestabilidad del raquis y realizamos revisión bibliográfica del tema. Nivel de Evidencia IV; Estudio de Caso-control.

Ultrasonic Bone Scalpel versus Conventional Technique for Thoracolumbar Spinal Decompression: A Prospective Randomized Controlled Trial / Bisturi ósseo ultrassônico versus técnica convencional para descompressão espinhal torácica: Um teste controlado randomizado prospectivo

Abstract Objective The purpose of the present study is to compare intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications in thoracolumbar spinal decompression using ultrasonic bone scalpels (UBSs) with conventional procedures. Methods Forty-two patients who underwent decompressive laminectomy and pedicular screw fusion with a surgical level of 1-5 levels between February 1, 2020, and June 30, 2022, in a single institution were evaluated for eligibility, and 11 were excluded due to a history of spinal surgery (n= 3), spinal tumor (n= 3), and spinal infection (n= 5). A total of 31 patients were randomly divided into the UBS group (n =15) and the conventional group (n =16). Intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications were recorded. Results Intraoperative blood loss and laminectomy time were significantly lower in the UBS group (656.0 ± 167.6 ml, 54.5 ± 27.4 minutes, respectively) than in the conventional group (936.9 ± 413.2 ml, 73.4 ± 28.1 minutes, respectively). Overall operation time, hospital length of stay, and complications were all similar between the groups. Conclusion The UBS is a useful instrument for procedures performed near the dura mater or other neural tissue without excessive heat or mechanical injury. This device is recommended for various spinal surgeries in addition to high-speed burrs and Kerrison rongeurs.

Resumo Objetivo O objetivo do presente estudo é comparar perda de sangue intraoperatória, tempo de operação, tempo de laminectomia, tempo de internação hospitalar e complicações na descompressão espinhal torácica utilizando bisturis ósseos ultrassônicos (BOUs) em relação aos procedimentos convencionais. Métodos Quarenta e dois pacientes submetidos a laminectomia descompressiva e fusão pedicular do parafuso com um nível cirúrgico de 1 a 5, entre 1° de fevereiro de 2020 e 30 de junho de 2022 em uma única instituição, foram avaliados para elegibilidade e 11 foram excluídos devido ao histórico de cirurgia espinhal (n= 3), tumor espinhal (n= 3) e infecção espinhal (n= 5). Perda de sangue intraoperatória, tempo de operação, tempo de laminectomia, tempo de internação e complicações foram registradas. Resultados A perda de sangue intraoperatória e o tempo de laminectomia foram significativamente menores no grupo BOU (656,0 ± 167,6 ml, 54,5 ± 27,4 min, respectivamente) do que no grupo convencional (936,9 ± 413,2 ml, 73,4 ± 28,1 min, respectivamente). O tempo de funcionamento total, o tempo de internação e as complicações foram todos semelhantes entre os grupos. Conclusão O bisturi ósseo ultrassônico é um instrumento útil para procedimentos realizados próximos à dura-máter ou outro tecido neural sem calor excessivo ou lesão mecânica. Este dispositivo é recomendado para várias cirurgias de coluna vertebral, juntamente com rebarbas de alta velocidade e pinça Kerrison.

Value of autologous platelet-rich plasma separation-retransfusion for blood conservation in patients undergoing thoracolumbar laminectomy / 中华麻醉学杂志

Objective:To evaluate the value of autologous platelet-rich plasma (aPRP) separation-retransfusion for blood conservation in the patients undergoing thoracolumbar laminectomy.Methods:Sixty American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-60 yr, with body mass index of 19-30 kg/m 2, scheduled for elective thoracolumbar laminectomy, were divided into 2 groups ( n=30 each) using a random number table method: conventional blood conservation group (group C) and aPRP blood conservation group (group aPRP). Group C received tranexamic acid and autologous blood salvage-retransfusion. Group aPRP received aPRP separation-retransfusion, tranexamic acid and autologous blood salvage-retransfusion. The volume of allogeneic blood transfused, percentage of patients who did not need the allogeneic blood transfusion and adverse reactions were recorded. Venous blood samples were collected for blood routine examination and for determination of the plasma concentrations of interleukin-6 (IL-6) and IL-10 at 1 day before operation (T 0), when the volume of blood loss reached 500 ml (T 1), immediately after surgery (T 2), and at 24 and 48 h after surgery (T 3, 4). The incidence of hypoxemia and amount of 24-h wound drainage were recorded. Results:Compared with group C, the amount of allogeneic red blood cells, plasma transfused and 24-h wound drainage were significantly decreased ( P<0.05), the percentage of patients who did not need the allogeneic red blood cell and plasma transfusion was increased (30% vs 47%, 10% vs 60%, P<0.05), the plasma concentrations of IL-6 and IL-10 at T 2-4 were significantly decreased ( P<0.05), and the incidence of hypoxemia in PACU was decreased in group aPRP (27% vs 10%, P<0.05). Conclusions:aPRP separation-retransfusion can provide marked improvement in conventional blood conservation in the patients undergoing thoracolumbar laminectomy.

Full-endoscopic technique through posterior cervical Delta large portal for cervical spondylotic myelopa-thy and radiculopathy / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of full-endoscopic technique through the posterior cervical Delta large portal for the treatment of cervical spondylotic myelopathy and radiculopathy.Methods:The clinical data were analyzed retrospectively of the 15 patients who had been treated for cervical spondylotic myelopathy or radiculopathy at Orthopedics Department, Jiaxing Xiuzhou District People's Hospital from January 2020 to June 2021. There were 6 males and 9 females, aged from 54 to 76 years (average, 66.2 years). Responsible levels: 3 cases of C3, 4, 4 cases of C4, 5, 7 cases of C5, 6 and 1 case of C6, 7. They were all treated by full-endoscopic technique through the posterior cervical Delta large portal. The therapeutic efficacy was assessed by comparing the neck disability indexes (NDI) and Japanese Orthopaedic Association (JOA) cervical scores at preoperation, 1 and 3 months post-operation, and the last follow-up, and the modified MacNab scores at the last follow-up. The operative effects on cervical curvature and segmental stability were assessed by comparing the C2-7 cobb angles and operative ranges of motion (ROM) at preoperation, 1 and 3 months postoperation, and the last follow-up.Results:All cases completed their operation successfully. The operation time ranged from 56 to 82 min (average, 65.7 min), and the intraoperative blood loss from 10 to 30 mL (average, 20.7 mL). Tissue infection, intraspinal infection, dural tear, nerve root injury or perioperative anesthesia-related complications occurred in none of the patients. All patients were followed up for 6 to 18 months (average 10.8 months). The NDIs at 1 and 3 months post-operation, and the last follow-up (18.54%±3.06%, 14.96%±2.33%, and 12.89%±2.33%) were significantly lower than that before operation (34.19%±3.83%), and those at 3 months postoperation and the last follow-up significantly lower than that at 1 month postoperation ( P<0.05), but there was no significant difference between 3 months postoperation and the last follow-up in NDI ( P>0.05). The JOA scores at 1 and 3 months postoperation, and the last follow-up [(12.28±1.65), (13.30±1.57) and (13.54±1.41) points] were significantly higher than the preoperative value [(9.25±1.49) points] ( P<0.05), but there was no such a significant difference between postoperative time points ( P>0.05). Comparisons between preoperation, 1 and 3 months postoperation, and the last follow-up showed no significant difference in the C2-7 cobb angle or operative ROM ( P>0.05). The modified MacNab scores at the last follow-up resulted in 9 excellent, 5 good and 1 fair cases. Conclusion:In the treatment of cervical spondylotic myelopathy and radiculopathy, the full-endoscopic technique through the posterior cervical Delta large portal shows the advantages of limited invasion and complications, rapid recovery after operation, and little impact on the cervical curvature and segmental stability.

Unilateral laminotomy for bilateral decompression under unilateral biportal endoscopy and uniportal endoscopy to treat lumbar spinal stenosis / 中华骨科杂志

Objective:To compare the clinical efficacy of unilateral biportal endoscopy (UBE) and uniportal endoscopy (UE) for unilateral laminotomy for bilateral decompression (ULBD) in the treatment of lumbar spinal stenosis.Methods:Data of 82 patients with lumbar spinal stenosis treated by ULBD under UBE or UE from January 2020 to June 2021 in Dalian Central Hospital affiliated to Dalian Medical University and the First Hospital affiliated to Wenzhou Medical University were retrospectively analyzed, including 36 males and 46 females, aged 63.3±7.5 years (range, 47-81 years). According to the surgical procedure, they were divided into UBE group (42 cases), including 20 males and 22 females; aged 63.2±7.6 years (range, 47-81 years) and UE group (40 cases), including 16 males and 24 females; aged 63.5±7.5 years (range, 48-80 years). Operation time, hospital stay and surgical complications were compared between the two groups. Visual analogue scale (VAS) of low back and leg pain before surgery, 1 day, 7 d, 1 month and 6 months after surgery, and Oswestry disability index (ODI) before surgery, 1 month and 6 months after surgery were compared. Dural sac area before and after surgery, resection angle of ipsilateral facet joint, decompression rate of disc space and bone lateral recess were calculated.Results:All patients were operated successfully. In the UBE group, the operation time was 63.1±7.0 min, and the hospital stay was 3.9±0.9 d. The UE group was 61.2±6.2 min and 3.7±0.9 d, respectively ( t=1.31, P=0.195; t=1.24, P=0.217). The VAS of back and legs pain in UBE group decreased from 7.19±0.97 before operation to 3.43±0.63 points at postoperative 1 day, 1.71±0.60 at postoperative 7 d, 1.33±0.48 at postoperative 1 month and 1.36±0.48 points at postoperative 6 months ( F=352.29, P<0.001). The VAS score of the UE group decreased from 6.85±0.89 points before operation to 2.45±0.75 points at postoperative 1 day, 1.75±0.59 points at postoperative 7 d, 1.33±0.47 points at postoperative 1 month and 1.28±0.45 points at postoperative 6 months ( F=291.44, P<0.001). The VAS of low back and leg pain was higher in the UBE group than in the UE group at 1 day postoperatively ( t=6.41, P<0.001), and the difference was not statistically significant at 7 d postoperatively ( t=-0.27, P=0.786). The ODI of UBE group decreased from 66.62%±4.98% before operation to 21.81%±2.61% at postoperative 1 month and 11.62%±2.31% at postoperative 6 months ( F=1991.35, P<0.001). The ODI score of UE group decreased from 64.35%±5.16% before operation to 22.85%±3.26% at postoperative 1 month and 11.15%±2.86% at postoperative 6 months ( F=1931.18, P<0.001). The postoperative dural sac area of the UBE and UE groups was 135.1±10.0 mm 2 and 120.9±10.4 mm 2 ( t=6.30, P<0.001). The resection angle of ipsilateral facet joint was 69.3°±4.9° and 94.3°±4.1° in the two groups, respectively, with a statistically significant difference ( t=-25.00, P<0.001). The decompression rate of ipsilateral disk-flavum space was 39.0%±3.0% and 38.7%±3.3% in the two groups ( t=1.52, P=0.314). On the contralateral side was 41.6%±3.3% and 22.8%±3.2% ( t=26.32, P<0.001), respectively. The ipsilateral osseous side fossa decompression rate in the two groups were 70.0%±4.8% and 59.3%±3.9% ( t=15.64, P<0.001), the contralateral were 73.0%±3.4% and 48.4%±4.3% ( t=28.86, P<0.001). There was no significant difference in the decompression rate of ipsilateral disco-flavum space or bony lateral recess between the UBE group and the contralateral group ( t=-1.40, P=0.174; t=-1.72, P=0.096), while the decompression rate of discoflavum space and bony side recess on the ipsilateral side of UE group were higher than those on the contralateral side ( t=28.51, P<0.001; t=13.95, P<0.001). Conclusion:Both UE-ULBD and UBE-ULBD have good short-term clinical efficacy in patients with lumbar spinal stenosis. UB is better than UBE in early postoperative pain relief. However, UBE shows better imaging performance in decompression effect and better retention of facet joints.

Mechanism of epidural scar hyperplasia after laminectomy induced by blood siltation / 中华骨科杂志

Objective:To explore the mechanism of epidural scar tissue hyperplasia induced by erythrocyte rupture and release of interleukin-33 (IL-33) after laminectomy in mice.Methods:In the zoological experiment, the operation group (Laminectomy) and the sham operation group were set, and HE staining and Masson staining were performed to test for blood accumulation in the operation area after laminectomy in mice. Then 12 wild-type mice with 6-8 week old were selected and divided into 4 groups: the sham operation group, the operation group (normal saline control), the pure red blood cell intervention operation group, the whole blood intervention operation group. The normal saline (100 mg/kg) was injected into the postoperative area. The red blood cells or whole blood with the same volume were injected into the postoperative area in the pure red blood cell intervention group and the whole blood intervention group. The postoperative recovery of mice in each group was observed. The levels of fibronectin in the postoperative scar tissues of mice in four groups were detected by western blot technology, and the degree of postoperative epidural scar hyperplasia was directly observed by immunohistochemistry. In the cytological experiment, the wild-type mouse erythrocyte normal saline group, the control group of IL-33 knockout mouse erythrocyte normal saline, the wild-type mouse erythrocyte lysis group, and the IL-33 knockout mouse erythrocyte lysis group were set. The levels of IL-33 in the red blood cells of four groups were detected by western blot. Then, a blank wild-type mouse erythrocyte control group, a wild-type mouse relative to the control group (only secondary antibody added to test for non-specific binding), a wild-type mouse erythrocyte group and an IL-33 knockout mouse erythrocyte group (to test for antigen specificity of the primary antibody) were set. Immunofluorescence staining was performed on the erythrocytes of four groups and the level of IL-33 was detected by flow cytometry.Results:HE staining and Masson staining after laminectomy showed that there was blood stasis in the local incision area of mice in the operation group. The epidural scar hyperplasia in the incision area of mice after whole blood or red blood cells intervention was higher, especially in the whole blood intervention group. IL-33 expression was almost undetectable in the wild-type erythrocyte normal saline control group, the IL-33-knockout erythrocyte normal saline control group, and the IL-33-knockout erythrocyte lysis group, while significant IL-33 expression was detectable in the wild-type erythrocyte lysis group. Immunofluorescence staining showed that IL-33 was expressed in and on the erythrocyte membrane of wild-type mice, while non-specific expression of IL-33 or a very small amount of IL-33 was almost undetectable in the other three groups. The immunofluorescence intensities of IL-33 in the four groups were 0.62±0.41, 60.17±4.39, 16.78±7.43 and 0.61±0.03, respectively ( F=281.90, P<0.001). The expression of IL-33 in the erythrocyte group of wild-type mice was the highest ( P<0.05). According to the results of flow cytometry, except for the trace amount of IL-33 detected in the wild-type mouse erythrocyte group, the expression of IL-33 in the other three groups was basically 0. The ratios of fibronectin to β-actin in the modeling area of the four groups gradually increased, and the ratios were 0.79±0.09, 1.26±0.23, 1.79±0.05 and 2.29±0.58, respectively, and the differences were statistically significant ( F=12.86, P=0.002). Fibronectin in the operation area of the three operation groups (normal saline control group, red blood cell intervention group and whole blood intervention group) was significantly higher than that of the sham operation group. The immunohistochemical staining results of fibronectin in the modeling area of the four groups were the same as those in western blot experiment. The average optical density values of fibronectin in each group were 0.09±0.01, 0.18±0.01, 0.22±0.01 and 0.24±0.01, respectively, and the difference was statistically significant ( F= 210.7, P<0.001). Conclusion:There is indeed blood accumulation in the surgical area after laminectomy in mice, and it can aggravate the hyperplasia of epidural scar tissue. Erythrocyte is the main component in blood, and there is a large amount of IL-33 expression in the inner and outer membrane of erythrocyte membrane. The mechanism of promoting the proliferation of epidural scar tissue may be related to the release of IL-33 by erythrocyte lysis.

Traitement chirurgical du Mal de Pott et de ses séquelles au Centre Hospitalier de l'Ordre de Malte Dakar / Surgical treatm ent of Pott's diseaseand its sequelae at the Hospital of the Order of Malta/Daka

Introduction. Evaluer les résultats du traitement chirurgical du Mal de Pott et de ses séquelles au Centre hospitalier de l'ordre de Malte de Dakar. Patients et méthodes. Nous présentons les résultats préliminaires d'une série consécutive de 23 patients (13 hommes et 10 femmes) d'âge moyen de 32,35 ans [6 ­70 ans] présentant des Maux de Pott ou de leurs séquelles nécessitant un traitement chirurgical. L'échelle d'incapacité d'Oswestry, l'échelle visuelle analogique et le score ASIA ont été utilisés pour l'évaluation clinique. Les radiographies pré opératoires, post opératoires et au recul ont été utilisés pour les résultats anatomiques. Tous ces patients ont été opérés selon trois stratégies opératoires sur une période de 67 mois (Avril 2014- Novembre 2019). Nous avons réalisé une laminectomie arthrodèse postérieure dans 52,2% ; une laminectomie plus OTP et arthrodèse postérieure dans 43,5% ; une discectomie et hémicorporectomie avec arthrodèse antérieure par plaque vissée de Roy Camille à l'étage cervical dans 4,3%. Résultats. La symptomatologie était dominée par la douleur rachidienne, la cyphose et les troubles neurologiques. La cyphose post opératoire était significativement améliorée (la moyenne passe de 48,52° en pré opératoire à 17,09° en post opératoire). On a obtenu 100% de fusion vertébrale. On note une nette amélioration de la douleur rachidienne (avec une baisse au recul de 55,44 points pour l'OID et de 5,66 pour l'EVA) ; 78,3% des patients étaient très satisfaits, 17,4% satisfaits et 4,3% mécontents. Conclusion. Le traitement chirurgical du Mal de Pott et de ses séquelles a fortement amélioré les rachis au Centre hospitalier de l'Ordre de Malte.

Introduction. To evaluate the results of the surgical treatment of Pott's disease and its sequelae at the Hospital Center of the Order of Malta in Dakar. Patients and methods. We present the preliminary results of a consecutive series of 23 patients (13 men and 10 women) with an average age of 32.35 years [6-70 years] presenting with Pott's disease or its sequelae requiring treatment. surgical treatment. Oswestry Disability Scale, Visual Analogue Scale and ASIA score were used for clinical assessment. Preoperative, postoperative and followup radiographs were used for anatomical results. All these patients were operated according to three operating strategies over a period of 67 months (April 2014- November 2019). We performed posterior laminectomy-arthrodesis in 52.2%; laminectomy plus OTP and posterior arthrodesis in 43.5%; discectomy and hemicorpectomy with anterior arthrodesis by Roy Camille screwed plate at the cervical level in 4.3%. Results. The symptomatology was dominated by spinal pain, kyphosis and neurological disorders. Postoperative kyphosis was significantly improved (the average goes from 48.52° preoperatively to 17.09° postoperatively). We got 100% spinal fusion. There is a clear improvement in spinal pain (with a drop at follow-up of 55.44 points for the OID and 5.66 for the EVA); 78.3% of patients were very satisfied, 17.4% satisfied and 4.3% dissatisfied. Conclusion. The surgical treatment of Pott's disease and its sequelae greatly improved the spines at the Hospital Center of the Order of Malta.

Spinal cord occupation ratio (SCOR) and its application in the diagnosis of cervical spinal cord compression in Mucopolysaccharidoses

Abstract Introduction Mucopolysaccharidoses (MPS) can lead to cervical spinal cord compression (SCC). Diagnostic scores for SCC in MPS use the obliteration of the passage of cerebrospinal fluid in the anterior and posterior spinal cord in the sagittal section of magnetic resonance imaging (MRI). The spinal cord occupation ratio (SCOR) published, by Nouri et al (2018), establishes the spinal cord filling index for the spinal cord, identifying disproportionate spinal cord occupation in the canal. When evaluating congenital canal stenosis, the risk of spinal cord injury has been considered increased when the SCOR is ≥70% in the median sagittal plane or ≥ 80% in the axial plane. Although these values ​​have not been validated for MPS populations, they could be useful. Objective To verify the SCOR in MPS patients with diagnosis of cervical SCC comparing the SCOR with other markers proposed in the existing MPS SCC scores, such as the extent of gliosis, clinical impact and the SCC assessment as represented by the obliteration of CSF flow. Methods We reviewed imaging tests of the cervical spine from MPS patients with previously confirmed SCC, using the SCOR measure in the median sagittal plane, evaluation of the presence and extent of spinal gliosis on MRI, evaluation of the clinical impact using a clinical score and evaluation of the images for the obliteration of cerebral spinal fluid (CSF) flow. Results Thirty-one MRI of 24 different patients were included. The average SCOR was 87.1%. This was lower (81.6%) in patients without gliosis, when compared to those with focal (90.5%) and extensive (97%) gliosis. The only patient with gliosis associated with a lacunar lesion, resulting from an acute compressive injury, had a 68% SCOR, due to the atrophic spinal cord injury. As expected, SCOR was higher in patients with total or partial CSF obliteration, but one among the 3 patients without CSF flow obliteration, with a 76% SCOR, had already developed focal gliosis and mild clinical abnormalities. Patients with more extensive gliosis had higher clinical scores. Four patients had more than one imaging scan evaluated. SCOR upward trend showed an annual average increase of 3.8%. Discussion & Conclusions The use of SCOR allows the diagnosis of cervical spinal canal stenosis in an objective way. It is possible that the cut-off values used by Nouri et al in patients with congenital stenosis could be useful to diagnose cervical stenosis in MPS patients, preceding the finding of CSF flow obstruction, presence of gliosis or clinical abnormalities. Furthermore, the use of SCOR may assist in the longitudinal evaluation of disease progression. Better follow-up and timely diagnosis allows for scheduling of surgery at the best clinical moment, minimizing complications.

Fibrosis epidural postquirúrgica: presentación de un caso con enfoque médico legal / Postsurgical epidural fibrosis: presentation of a case with a medical-legal approach

Resumen La fibrosis epidural es un hallazgo clínico y radiológico el cual se encuentra relacionado directamente en su génesis con los procedimientos quirúrgicos realizados en la columna vertebral. Esta patología es la causa más frecuente del síndrome de cirugía fallida de columna, manifestada clínicamente como un dolor equiparable en severidad al presentado previo a la intervención quirúrgica realizada. La fibrosis epidural es parte del proceso de cicatrización usual de los tejidos circundantes de la columna vertebral, en otras palabras, es esperable que esta suceda, sin embargo, solo una mínima cantidad de las personas intervenidas desarrollan clínicamente la sintomatología. La importancia del análisis de esta patología radica en que estas valoraciones son ingresadas al Departamento de Medicina Legal por asunto de reagravación de alguna secuela ocasionada por algún evento traumático. Es imprescindible conocer a profundidad los diferentes aspectos etiológicos, fisiopatológicos, clínicos, radiológicos y terapéuticos que involucran esta patología vertebral, así como, el respectivo análisis médico legal en este tipo de casos, tomando en consideración todos los elementos de juicio que permitan relacionar este hallazgo con algún hecho denunciado. En el presente artículo se realizará un análisis médico legal de un caso de reagravación por fibrosis epidural valorado en el Departamento de Medicina Legal de Costa Rica, donde el peritado interpone una denuncia contra el ente asegurador al ser rechazada la posibilidad de reapertura del riesgo laboral presentado.

Abstract The epidural fibrosis is a clinical and radiological finding that is related with the surgical procedures performed on the spine. This pathology is the most frequent cause of failed back syndrome or post laminectomy syndrome, that is clinically manifested by an acute pain comparable in severity with the surgical intervention. Epidural fibrosis is part of the usual healing process of the surrounding tissues of the spine, in other words, it's to be expected as a result of this procedures, nevertheless, only a small number of people who have been intervened, actually develop the symptoms clinically. The importance of this pathology lies in the fact that these assessments are attended in the Legal Medicine Department due to the aggravation issues of any sequel caused by a traumatic event. It is essential to know such things as the etiology, pathophysiology, clinical manifestations, radiological findings, and the therapeutic aspects that involve this vertebral disease, as well as, the respective forensic analysis, in order to use all the elements of judgment that allows to relate what is documented with the denounced findings.

Reporte de caso: Quiste neuroentérico intradural/extramedular en paciente joven / Case report: Intradural/extramedullary neurenteric cyst in a young patient

Introducción: Los quistes neuroentéricos son lesiones congénitas, benignas, solitarias e infrecuentes del eje espinal, compuestas de tejido endodérmico heterotópico, productos del cierre incompleto del tubo neural. Se presentan, principalmente, en hombres durante la primera y segunda década de vida. Se localizan mayoritariamente en el espacio intradural/extramedular, ventralmente a la médula espinal, a nivel cervical bajo o torácico superior. La sintomatología neurológica depende de la localización del quiste. El diagnóstico presuntivo se realiza con una resonancia magnética, y el definitivo con un estudio histopatológico, llevado a cabo posterior a la exéresis completa o parcial de la muestra, con abordaje posterior, en la mayoría de los casos. Caso: Se describe el caso de una paciente de 35 años, quien tiene antecedente de haber presentado a los 14 años un quiste neuroentérico intradural/extramedular, a nivel cervial bajo. Había debutado con cervicalgia irradiada a miembros superiores e inferiores, radiculopatía, pérdida de la fuerza muscular, e hiperreflexia. Se realizó en ese momento una resonancia magnética, evidenciando una lesión ocupante de espacio en C5 y C6, la cual fue intervenida quirúrgicamente a través de una laminectomía en C5-C6 con abordaje posterior. Se realizó exéresis completa de la misma. El estudio anatomopatológico reportó quiste neuroentérico intradural/extramedular, sin atipias celulares. La evolución posoperatoria de la paciente resultó satisfactoria. Conclusión: Se describe este caso clínico, resaltando su importancia, al tratarse de lesiones sumamente infrecuentes en la literatura médica, con sintomatología poco específica, pudiendo confundirse con otras patologías, y recidivar, incluso después de haberse extraído completamente

Introduction: Neuroenteric cysts are congenital, benign, solitary, and infrequent lesions of the spinal axis, composed of heterotopic endodermic tissue, resulting from an incomplete closure of the neural tube. They mainly occur in men, during the first or second decade of life. Most of these cysts are located in the intradural/extramedullary compartment, ventrally to the spinal cord, especially at the lower cervical or upper thoracic spine. The neurological symptomatology varies depending on the location of the cyst. The presumptive diagnosis is made with magnetic resonance imaging, and the definitive diagnosis is made with a histopathological assessment, which is done after a complete or partial resection of the mass, generally with a posterior approach. Case presentation: We describe the case of a 35-year-old female patient, with the medical history of presenting an intradural/extramedullary neuroenteric cyst, located at the lower cervical level, at the age of 14. She presented cervical pain irradiated to upper and lower limbs, radicular pain, loss of muscular strength, and hyperreflexia. A magnetic resonance imaging was indicated, showing a space-occupying lesion at the C5 and C6 levels, which was surgically intervened through a posterior cervical (C5-C6) laminectomy. A complete resection of this mass was performed. The histopathological assessment reported an intradural/extramedullary neuroenteric cyst, with no cellular atypia. The patient's postoperative progress and development were satisfactory. Conclusion: The objective is to describe this case, highlighting its importance, since these lesions are extremely infrequent in the medical literature, with a non-specific symptomatology, which is why they can be confused with other pathologies, and recur, even after their complete resection.

Meningocele sacro anterior gigante y síndrome de Currarino incompleto en paciente adulta: reporte de un caso

Anterior sacral meningocele is a protrusion of the dural sac through a bone defect in the sacrum anterior wall. It can occur in isolation or be associated with other malformations, such as the Currarino syndrome, which is part of the classic triad together with hemisacrum and anorectal malformation, although it has great variability. This is the case of an adult woman with chronic constipation, recurrent urinary infection and marked abdominal distension, diagnosed with giant anterior sacral meningocele and incomplete Currarino syndrome. The patient underwent a sacral laminectomy and thecal sac ligation at the level of the bone defect. This article describes this rare type of occult spinal dysraphism as well as the surgical technique used.

Experimental Study of Hemilaminectomy, Total Laminectomy and Recapping laminoplasty of Cervical Spine in Sheep / 医用生物力学

Objective To study the effect of hemilaminectomy, total laminectomyand recapping laminoplasty on stability of the cervical spine. Methods Fourteen fresh adult sheep cervical spine specimens were divided into two groups, with 7 cases in each group. Each specimen was applied with a pure moment load of 3.0 N·m under flexion/extension, left/right lateral bending, and left/right axial rotation. The range of motion (ROM) and neutral zone (NZ) of specimens were measured. In the first group, the ROMs and NZs of the specimens were measured and compared under the intact state, C5 hemilaminectomy state and C4-6 hemilaminectomy state respectively. In the second group, the ROMs and NZs of specimens under the intact state, C4-6 total laminectomy state and C4-6 recapping laminoplasty state were measured and compared. Results There were no significant differences in ROMs and NZs between C5 hemilaminectomy state and C4-6 hemilaminectomy state compared with the intact state (P<0.05). Compared with the intact state, ROMs of the specimens were significantly increased during flexion and extension under C4-6 laminectomy state and C4-6 recapping laminoplasty state (P<0.05). In addition, compared with the C4-6 laminectomy state, ROMs of the specimen were significantly decreased only during extension unde C4-6 recapping laminoplasty state (P<0.05), while no significant differences were found in ROMs between total laminectomy and laminoplasty under other loads. Conclusions With hemilaminectomy, ROMs and NZs of the cervical spine did not increase significantly, and stability of the cervical spine was not affected. With C4-6 total laminectomy, ROMs and NZs during flexion and extension increased significantly, and stability of the cervical spine was affected. Recapping laminoplasty did not significantly improve stability of the cervical spine with total laminectomy.

Tumor maligno de columna vertebral / Malignant tumor of the spine

RESUMEN Introducción: Los tumores de columna vertebral son neoplasias poco comunes que pueden ser de origen primario o secundario. Las de origen primario son las que se presentan con menor recurrencia clínica, y se caracterizan generalmente por manifestaciones de dolor a nivel local y en menor proporción, por afectación neurológica. Objetivo: Describir el proceso de diagnóstico de un paciente con tumor de columna lumbar, el tratamiento recibido y su evolución. Caso clínico: Paciente de 77 años de edad con cuadro clínico consistente en dolor lumbar, paresias y parestesias. Se realizaron ayudas diagnósticas como radiografía y tomografía, en las que se evidenció una extensa lesión tumoral de la columna lumbar, valorada por cirugía de columna. Se realizó laminectomía descompresiva a nivel de L4 bilateral, artrodesis de T12 a L5 y se tomó biopsia abierta del tumor de la columna. Después de la cirugía la paciente presentó mejoría de la sintomatología. El informe anatomopatológico del tumor evidenció un tumor maligno indiferenciado. Conclusiones: El diagnóstico de tumor en columna lumbar se basa en evidencia clínica, imágenes diagnósticas, biopsia e inmunohistoquímica; una vez realizado el diagnóstico, el tratamiento debe incluir una combinación de quimioterapia, radioterapia y cirugía. La tomografía axial computarizada se utiliza como ayuda quirúrgica. Durante el procedimiento quirúrgico es pertinente realizar la resección de la lesión y obtener una confirmación histológica para definir el tratamiento antineoplásico y la malignidad de dicho tumor. El tratamiento oportuno reduce el riesgo de daño neurológico y mantiene la estabilidad mecánica espinal(AU)

ABSTRACT Introduction: Spinal tumors are rare neoplasms that can be of primary or secondary origin. Those of primary origin are those that present with less clinical recurrence, and are generally characterized by manifestations of local pain and to a lesser extent, by neurological involvement. Objective: To describe the diagnostic process of a patient with lumbar spine tumor, the treatment received and the evolution. Clinical report: We report a case of a 77-year-old patient, with a clinical situation of low back pain, paresis and paresthesias. Diagnostic aids such as radiography and tomography were performed, which showed an extensive tumor lesion of the lumbar spine, it was assessed for spinal surgery. Decompressive laminectomy was performed at the bilateral L4 level, arthrodesis from T12 to L5, and an open biopsy of the spinal tumor was taken. The patient had improvement in symptoms after surgery. The pathological report of the tumor showed an undifferentiated malignant tumor. Conclusions: The diagnosis of lumbar spine tumor is based on clinical evidence, diagnostic images, biopsy and immunohistochemistry. Once the diagnosis is made, treatment should include a combination of chemotherapy, radiation therapy, and surgery. Computerized axial tomography is used as a surgical aid. During the surgical procedure, it is pertinent to resect the lesion and to obtain histological confirmation to define the antineoplastic treatment and the malignancy of said tumor. Prompt treatment reduces the risk of neurological damage and maintains spinal mechanical stability.

Estenosis lumbar degenerativa: conceptos básicos, evaluación clínica y manejo / Degenerative lumbar spinal stenosis: basic concepts, clinical evaluation, treatment

La estenorraquis lumbar es la disminución del volumen del canal raquídeo en la columna. Es la causa más frecuente de dolor lumbociático y lumbocrural en población mayor de 60 años. Existen múltiples causas. La más común es la degenerativa que consiste en una disminución del canal secundario a varios factores como protrusión del disco intervertebral, hipertrofia y abombamiento del ligamento amarillo, engrosamiento de la capsula articular y por osteofitos. Los síntomas principales son el dolor lumbar irradiado a extremidades inferiores tipo lumbociática o lumbocruralgia y la claudicación neural intermitente. Generalmente no hay déficit motor ni sensitivo. La resonancia magnética es el estudio de elección para el diagnóstico, pero debe complementarse con radiografías y con frecuencia con tac para una mejor valoración de la patología. El tratamiento inicial siempre es conservador, que incluye uso de antiinflamatorios, analgésicos, relajantes musculares, kinesioterapia e infiltraciones de columna (epidurales o radiculares). La mayoría de los pacientes responden satisfactoriamente a este manejo. El tratamiento quirúrgico está indicado a los pacientes que presentan un dolor intenso, que afecta su calidad de vida y que no mejora con el tratamiento conservador. Consiste en la descompresión quirúrgica de las raíces lumbares a través de laminectomía. En ocasiones se recomienda complementar la descompresión con artrodesis específicamente cuando la estenorraquis se asocia a otras condiciones como espondilolistesis degenerativa, escoliosis, desbalance sagital o coronal, inestabilidad segmentaria y en enfermedad del segmento adyacente.

Spinal lumbar stenosis is a narrowing of the spinal canal in the lumbar spine. Is the most frequent cause of sciatic pain or cruralgia in the elderly population over 60 years old. Exist many etiologies. The most common is degenerative caused by many factors including bulging disc, hypertrophy of flavum ligament as well as facet capsule thickening and by osteophytes formation. The main symptoms of spinal stenosis are radicular pain and neurogenic claudication. Lumbar flexion usually improves the symptom and deambulation often worsens the pain. Most of the time neurologic examination is normal. The gold standard study is mri but is necessary to complement with x rays and ct to obtain a better evaluation. Initial treatment is always conservative and consists in nsaid's, muscle relaxants, physical therapy and steroid spinal injections. Most of the patients respond well to this treatment. Surgical treatment is indicated when the patient has a severe pain, quality of life is miserable and conservative treatment fails. Decompression is the gold standard surgical treatment. The addition of an arthrodesis or spinal fusion is recommended in degenerative spondylolisthesis, scoliosis, sagital or coronal imbalance, deformity correction, recurrent spinal stenosis and in cases of adjacent level disease problem.

Transforaminal intersomatic lumbar arthrodesis: comparison between autograft and cage in peek / Artrodese lombar intersomática transforaminal: comparado autoenxerto e cage-peek

ABSTRACT Objective: To compare the postoperative outcomes of transforaminal intersomatic lumbar arthrodesis with structured iliac bone autograft and PEEK device. Methods: The total of 93 medical records of patients undergoing transforaminal intersomatic fusion between January 2012 and July 2017 with at least 1 year of postoperative follow-up, with complete medical record, containing clinical file and radiological exams, were reviewed. Results: From the medical records evaluated, 48 patients underwent the procedure with structured iliac autograft (group 1) and 45 with PEEK device (group 2). There was an improvement in functional capacity in both groups (p < 0.001), however there was no difference when comparing them (p = 0.591). Conclusion: The postoperative clinical and radiological results of lumbar arthrodesis with TLIF technique, using a structured iliac bone autograft compared to a PEEK device, were similar. Level of Evidence II, Retrospective study.

RESUMO Objetivo: Comparar os desfechos pós-operatórios da artrodese lombar intersomática transforaminal com autoenxerto ósseo ilíaco estruturado e dispositivo em poliéter-éter-cetonico-polímero (PEEK). Métodos: Foram revistos 93 prontuários de pacientes submetidos à fusão intersomática transforaminal entre janeiro de 2012 e julho de 2017 com pelo menos um ano de acompanhamento pós-operatório, com prontuário completo, contendo ficha clínica e exames radiológicos. Resultados: Dos prontuários avaliados, 48 pacientes foram submetidos ao procedimento com autoenxerto ilíaco estruturado (Grupo 1) e 45 com dispositivo em PEEK (Grupo 2). Houve melhora da capacidade funcional em ambos os grupos (p < 0,001), no entanto não houve diferença ao compará-los (p = 0,591). Conclusão: Os resultados clínicos e radiológicos pós-operatórios da artrodese lombar na técnica Fusão Intersomática Lombar Transforaminal (TLIF) utilizando autoenxerto ósseo ilíaco estruturado, em comparação com o uso de dispositivo em PEEK, foram semelhantes. Nível de Evidência II, Estudo retrospectivo.

Effect of platelet-rich plasma, fat pad and dural matrix in preventing epidural fibrosis / Efeito do plasma rico em plaquetas, enxerto de gordura e matriz de colágeno na prevenção da fibrose epidural

ABSTRACT Objective: Epidural fibrosis is one of the main reasons for requiring repeated surgical intervention. Our objective was to compare the effect of Platelet Rich Plasma (PRP) on the development of epidural fibrosis with collagen dural matrix and free autogenous fat graft. Methods: Male rats were separated into 3 groups. Laminectomy was implemented on the rats and epidural fat pad was placed in the first group (n = 7); equal size of collagen dural matrix was applied in the second group (n = 7); a single dose of PRP was applied in the third group (n = 7). Results: Epidural fibrosis was more common in the group that collagen dural matrix was applied when compared the ones that PRP was applied. PRP group presented better values in preventing epidural fibrosis when compared to the fat pad group, however this difference was not statistically significant. Conclusion: PRP is a material that can be easily obtained from the very blood of patients and at an extremely low cost; the main clinical relevance of our study is that the PRP might be an efficient material for better clinical results after laminectomy surgery due to its tissue healing and epidural fibroris preventing potentials. Level of Evidence V, Animal research.

RESUMO Objetivo: A fibrose epidural é uma das principais razões que motiva intervenções cirúrgicas repetidas. O objetivo deste estudo foi comparar o efeito do plasma rico em plaquetas (PRP) no desenvolvimento de fibrose epidural com matriz de colágeno e enxerto de gordura autógena. Métodos: Ratos machos foram separados em 3 grupos. A laminectomia foi aplicada nos ratos e gordura epidural foi colocada no primeiro grupo (n = 7); matriz de colágeno de tamanho igual foi aplicada no segundo grupo (n = 7); uma dose única de PRP foi aplicada no terceiro grupo (n = 7). Resultados: A fibrose epidural foi mais comum no grupo em que a matriz de colágeno foi aplicada, quando comparada aos animais do grupo PRP. O grupo PRP apresentou os melhores valores na prevenção da fibrose epidural quando comparado ao grupo enxerto de gordura, porém a diferença não foi estatisticamente significante. Conclusão: PRP é um material de fácil obtenção do sangue dos pacientes e a baixo custo; a principal relevância clínica de nosso estudo é que o PRP pode ser um material eficiente para obter melhores resultados clínicos após a laminectomia devido à sua cicatrização tecidual e potencial de prevenção de fibrose epidural. Nível de evidência V, Pesquisa com animais.