Postoperative fibrosis after surgical treatment of the porcine spinal cord: a comparison of dural substitutes

spinal dura mater or to enlarge the spinal dural sac is not an infrequent requirement in neurosurgery. Some of the more common spinal conditions include Chiari malformations, tethered cord, syringomyelia, and malignant intradural tumors. A postoperative inflammatory reaction followed by fibrosis involving the arachnoid membrane may lead to various complications. When dense adhesions between the spinal cord and the overlying dura mater occur, arachnoiditis, tethering, and neurological deterioration may ensue. The search for the ideal dura mater substitute continues. Autologous sources include fascia lata and pericranium, and one of the most common is cadaveric dural allograft. Various synthetic or organic grafts have been used with inconsistent results.4,7,12,15,17,18 No single dural substitute has gained wide acceptance. The ideal substitute produces a minimal inflammatory reaction, has excellent suture-related properties, comes in a variety of shapes and sizes, is inexpensive, and is associated with a low incidence of CSF leakage. In a porcine model, we compared the adhesion formation, fibrosis, inflammatory response, foreign-body reactions, and spinal cord changes after placement of four commonly used dural substitutes—Surgicel, Durasis, DuraGen, and Preclude—in the lumbar subdural space.