Histological effects of fibrin glue and synthetic tissue glues on the spinal cord: are they safe to use?

Abstract

Introduction: Fibrin glues such as Tisseel® have been established in neurosurgery for over thirty years. They are recommended for extradural use but have intradural applications. Brachial plexus reimplantation after trauma requires intradural fibrin glue because reimplanted nerves cannot be sutured to the spinal cord. Recently synthetic glues have become popular in spinal surgery but there is limited information about their safety. Our study compared the histological effects of Tisseel®, Adherus® and BioGlue® on spinal cord using our rat brachial plexus repair model.Materials & methods: Randomised observational animal study. Forty-one Sprague-Dawley rats divided in to control (n = 9), Tisseel® (n = 8), BioGlue® (n = 10) and Adherus® (n = 14) groups. Under general anaesthesia a posterior midline cervical incision was made and hemi-laminectomies performed at C7 and T1. Dura was opened and T1 dorsal root transected and repositioned on the spinal cord. Two drops of Tisseel®, BioGlue®, Adherus® or no glue (control) were applied over the cut nerve and cord. At days 7, 14 and 28 rats were euthanized, processed and sections stained with Haematoxylin & Eosin and evaluated blind by a neuropathologist.Results: Control and Tisseel® groups showed only mild focal inflammation in the cord. Adherus® and Bioglue® groups showed evidence of spinal cord inflammation and degeneration. All BioGlue® and Adherus® rats had evidence of distortion of the cord from the glue mass at all time points. Two BioGlue®-treated and one Adherus®-treated rat developed a hemiparesis. One BioGlue® rat developed hind limb paralysis. One BioGlue® rat failed to wake up at the end of the procedure. There were no complications in control and Tisseel® groups.Conclusion: Tisseel® caused a similar inflammatory response to control and may be used on spinal cord. BioGlue® and Adherus® should be applied thinly for a watertight dural closure but intradural use and contact with spinal tissue must be avoided.