Introduction: Para-neural scar formation can occur after any spine surgical decompressive procedure when the neural elements are exposed. This can result in poor patient outcomes and can make re-operative procedures challenging. Many patients with para-neural scar formation suffer poor outcomes. This may be caused by restriction of normal physiologic movement of nerve root fascicles with activity. Prior attempts to reduce or eliminate para-neural scar formation have been unsuccessful.
Methods: A retrospective analysis was made of patients that underwent minimally invasive lumbar decompression procedures including microdiscectomy (n=6) , laminectomy (n=6), and interbody fusion (n=6) with direct neural decompression. These patients had local morselized autograph bone applied to biologically reconstruct the laminar defect prior to closure. Patients were evaluated with post-operative MRI 6mo to two years following surgical decompression. This cohort of patients was compared to patients undergoing traditional decompression without reconstruction of the laminar defect (n=12). Additional analysis was made of the position of the cauda equina nerve roots within the thecal sac.
Results: Those patients undergoing biological laminar reconstruction had significantly less para-neural scar formation as compared with those undergoing decompression alone (P<0.05). Inspection of the cauda equina nerve roots found that those patients having undergone biologic laminar reconstruction had nerve root anatomy similar to normal non-operated segments of the spine (i.e., nerve fascicles were located more centrally and of normal anatomic diameter). Those patients with decompression alone where found to have nerve root fascicles located more peripherally and where larger in diameter or clumped together.
Conclusions: This study suggest that biological laminar reconstruction with autologous bone graft material may lead to less para-neural scaring. Additionally normal anatomical nerve root fascicle diameter and location within the thecal sac appears to be better preserved with biologic laminar reconstruction. Therefore, biological laminar reconstruction may lead to improved patient outcomes and reduce the need for surgical re-operation.
Patient Care: Biological laminar reconstruction can potentially improve patients outcomes by reducing the incidence of para-neural scar formation.
Learning Objectives: To learn the technique of biological laminar reconstructions using local autograph bone to improve patient outcomes.