Spinal fixation after laminectomy in pigs prevents postoperative spinal cord injury

Background:A safe,effective,and ethically sound animal model is essential for preclinical research to investigate spinal medical devices.We report the initial failure of a porcine spinal survival model and a potential solution by fixating the spine.Methods:Eleven female Dutch Landrace pigs underwent a spinal lumbar interlaminar decompression with durotomy and were randomized for implantation of a medical device or control group.Magnetic resonance imaging(MRI)was performed before termination.Results:Neurological deficits were observed in 6 out of the first 8 animals.Three of these animals were terminated prematurely because they reached the predefined humane endpoint.Spinal cord compression and myelopathy was observed on postoperative MRI imaging.We hypothesized postoperative spinal instability with epidural hematoma,inherent to the biology of the model,and subsequent spinal cord injury as a potential cause.In the subsequent 3 animals,we fixated the spine with Lubra plates.All these animals recovered without neurological deficits.The extent of spinal cord compression on MRI was variable across animals and did not seem to correspond well with neurological outcome.Conclusion:This study shows that in a porcine in vivo model of interlaminar decompression and durotomy,fixation of the spine after lumbar interlaminar decompression is feasible and may improve neurological outcomes.Additional research is necessary to evaluate this hypothesis.

椎板间入路治疗腰椎间盘突出症

目的研究椎板间入路显微椎间盘切除术治疗腰椎间盘突出症的手术效果。方法对36例病人行显微椎间盘切除术，术中对椎间盘碎片及纤维环缺损情况进行评估，分析术前资料和术后随访情况。结果椎板间入路在28例（78％）病人中可充分暴露椎间隙，部分椎间孔扩大术在17例（47％）病人中使用。碎片一裂隙型及碎片，包含型病人手术效果最好，复发率低。结论椎板间入路是治疗腰椎间盘突出症的一种安全、有效的手术技术，椎间盘突出类型及椎间盘切除术后纤维环的完整性对预测腰腿痛复发有价值。