Bioresorbable film for the prevention of adhesion to the anterior spine after anterolateral discectomy

Background contextThe development of scar tissue and adhesions postoperatively is a natural consequence of healing but can be associated with medical complications and render reoperation difficult. Many biocompatible products have been evaluated as barriers or deterrents to adhesions.PurposeTo evaluate the efficacy of a bioresorbable polylactide film as a barrier to adhesion formation after anterolateral discectomy.Study designExperimental study.MethodsSeven, skeletally mature female sheep underwent a retroperitoneal approach to the anterolateral lumbar spine. A discectomy was performed at two levels with an intervening unoperated disc site. One site was treated with a polylactide film barrier (Hydrosorb Shield; MacroPore Biosurgery, San Diego, CA) affixed with tacks manufactured from the same material. The second site was left untreated. Treatment and control sites were randomly assigned. Postmortem analysis included scar tenacity scoring on five spines and histological evaluation on two spines.ResultsThe application of the Hydrosorb film barrier allowed a definite dissection plane during scar tenacity scoring and there was a significant difference in the development of adhesions to the disc between the control and treated sites. Histological evaluation revealed evidence of barrier formation to scar tissue and no significant adverse inflammatory reactions.ConclusionsHydrosorb Shield appears to be an effective postoperative barrier to scar tissue adhesion after anterolateral discectomy. The use of polylactide tacks was beneficial to affix the barrier film in place. Safety issues associated with delayed healing or adverse response to the film or tacks were not observed. Hydrosorb film may be useful as an antiadhesion barrier facilitating dissection during surgical revision in anterior approaches to the spine. Further studies are indicated to evaluate the performance of the bioresorbable material as an antiadhesion barrier in techniques of spinal fusion and disc replacement.