Results of a Bioresorbable Hydrogel Sheet Utilized as an Adhesion Barrier in Spine Surgery

Research Article | Open Access | Volume 9 | Issue 1

  • 1. Texas Spine Care Center, San Antonio, Texas, USA
  • 2. Research Source, Austin, Texas, USA
+ Show More - Show Less
Corresponding Authors
Kelly Van Schouwen, 3619 Paesanos Pkwy, Suite 302, San Antonio, Tx 78231, USA, Tel: 512-751-7747, E-Mail: kelly@researchtex.com

Background/Intro: Scar tissue following spine surgery is expected, but hypothesized to be related to complications such as incidental durotomy, vessel injury, further increase in scar tissue formation, failed back surgery syndrome, and diminished patient outcomes. Scar tissue prevention remains elusive, but advancements in adhesion barriers have shown compelling results in minimizing complications.

Methods: A retrospective review of one orthopedic surgeon’s patients that received VersaWrap (VW) during spine surgery. VW is a bioresorbable hydrogel sheet made of polysaccharides alginate and hyaluronic acid designed to separate tissues, allow gliding and prevent tethering.

Pre-operative demographics, surgical details, patient reported outcomes, complications, and reoperations were collected and analyzed for all patients. Statistical analysis was completed on the appropriate data using a paired t-test.

Results: Data for 169 patients that received posterior lumbar decompression were collected and analyzed. Patient reported outcomes showed significant improvement (p<0.05) in mean scores from pre-operative to 3-month follow-up for Visual Analogue Scale (VAS) neck/arm, VAS back/leg, NDI, and ODI. Four complications were reported, all peri-operative incidental durotomies that were repaired during surgery with no lasting impacts. Eleven patients underwent reoperations, unrelated to VW, but allowed for visual inspection of the VW post-operatively.

Conclusion: The use of VW during spine surgery appears to reduce potential complications from scar tissue formation, specifically in the event a reoperation occurs in the same anatomic region.

There are limitations to this study, including that it is retrospectively collected, but exploration of adhesion barriers in spine surgery applications appear promising and warrant further study.


Adhesion barriers;

Scar tissue;

Spine complications;

Epidural fibrosis


Bruggeman A, Van Schouwen KF (2022) Results of a Bioresorbable Hydrogel Sheet Utilized as an Adhesion Barrier in Spine Surgery. JSM Neurosurg Spine 9(1): 1104.


VW: VersaWrap, VAS: Visual Analogue Scale, ODI: Oswestry Disability Index, FBSS: Failed Back Surgery Syndrome, EF: Epidural Fibrosis, CMC: carboxymethylcellulose, PEO: polyethylene oxide, EBL: Estimated Blood Loss, MITR: Minimally Invasive Tubular Retractor.


Dural tearing is a well-known complication during reoperation of posterior spine procedures [1]. This tearing is often the indirect result of scarring from the initial procedure which tethers sensitive dura and opposing neural anatomy that are normally separated tissues [1-4]. Epidural Fibrosis (EF), scar tissue in proximity to nerve root, has been reported as the 3rd most common cause of failed back surgery syndrome (FBSS) [5], with the hypothesis that dural tethering to surrounding tissues as a result of EF is likely a cause [1]. FBSS is reported in a wide range of patients (4-60%), but the etiology is complex and includes a variety of potential contributing factors [5-13]. The rate of spine surgeries continues to climb in the US, and therefore reoperations continue to increase. While the overall reoperation rates following spine surgery are difficult to quantify, it is well understood that patient success rates decline with each subsequent surgery [10, 14,15].

Diagnosis of FBSS or a new pathology, particularly in minimally invasive procedures, can lead to reoperation in the same region as the initial surgery. Although this reoperation rate is difficult to quantify in the literature, the increased risk of complications during and after reoperation in the presence of scar tissue and EF is well documented [16-20]. These complications include incidental durotomy, vessel injury, further increase in scar tissue formation, greater risk of FBSS, and diminished patient outcomes [13, 21-23].

Historically, direct treatment for EF post-formation is limited, with options such as epidural lysis and epiduroscopy. These postoperative interventions have shown some effectiveness, as confirmed by imaging [24], but often still lead to reoperation [3,25-28]. Previous studies report preventative interventions including antiepileptics, nonsteroidal anti-inflammatories, antidepressants, opioids, fat grafts, suction drains, epidural steroid injections, adhesion barriers, adhesiolysis procedures, radiofrequency ablation, and neuromodulation [1,4,29-33,1,34-39]. Some of these efforts present compelling results in animal [37,39-41] and in limited human populations [30,33,42-44], which is encouraging for both surgeons and patients since preventative interventions are more appealing than postformation treatment.

Of all prophylactic options, adhesion barriers are preferred as there seems to be the greatest promise for success that does not require ongoing intervention. Adhesion barriers refer to a general classification of products used to prevent tissue tethering (and, thus, EF) by mechanically separating tissues or by allowing tissues to glide against one another with reduced friction [33,37- 39,42,45-48].The goal of an adhesion barrier is to prevent unwanted tethering of adjacent tissues that is initiated during the early stages of healing. Theoretically this early disruption of adhesion formation prevents permanent tethering that occurs during late stages of healing.

Adhesion barrier technologies initially included fat grafts, a practice still used today [49]. While there is some success with limiting EF adhesion, fat grafts have unintended consequences of neural compression, causing increased pain for patients. The adhesion barrier evolution has produced carboxymethylcellulose / polyethylene oxide (CMC/PEO) [33, 45], gelatin USP products [42], bacterial cellulose with mesenchymal stem cells [37], human amniotic membrane and placental-derived tissue barriers, and carbohydrate polymer gels [38,39].These products have widely been advertised to prevent adhesions, particularly for use in spine procedures, yet there is a paucity of literature to support these claims [47,50,51]. There is currently no standard of care for protection or management of nerve root during spine procedures.

VersaWrap® (Alafair Biosciences, Austin, Texas) is a new option unique from previous barrier technologies. VersaWrap® is plant-based, comprised of well-known hydrophilic polysaccharides alginate and hyaluronic acid. The device is a thin bioresorbable hydrogel sheet that transitions into a viscous gelatinous layer once implanted. This transition precludes the need for suturing or tissue glue, making device application quick and easy. Previous literature reports successful prevention of adhesions in a rat abdominal model [52], and initial clinical results for placement of the hydrogel device in recurrent cubital tunnel procedures appear promising [53].

The present study is a large, retrospective series of patients receiving VersaWrap® (hydrogel device) utilized as an adhesion barrier to prevent postoperative tethering of the nerve root to surrounding tissues such as bone, dura, and muscle in posterior approach decompression procedures.


The study is a retrospective review of operative and medical records of patients that received posterior approach lumbar spine decompression surgery with the use of the hydrogel device by one orthopedic spine surgeon. A waiver of consent was received to collect data of adult patients receiving surgery between May 2018-March 2020 with a minimum of 3-month postoperative follow-up.

Patient charts were reviewed for baseline (pre-operative)demographics, surgical details, and postoperative outcomes. Baseline demographics included patient age at surgery, gender, BMI, and smoking status. Surgical details collected were Estimated Blood Loss (EBL), type/spine levels of surgery, operative time, and operative complications. Patient reported outcomes, including Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) were collected and statistically analyzed using a paired t-test. Reoperations were collected and analyzed at all available post-operative time points.

Product Description and Application

VersaWrap® (Figure 1)

Figure 1 VersaWrap® is a class II medical device that consists of a  clear hydrogel plant-based sheet and a wetting solution provided in a  dropper bottle. The wetting solution is applied to the sheet to render  the sheet a gelatinous tissue adherent layer that separates target  tissues from surrounding tissues to prevent unwanted postoperative  tethering.

Figure 1 VersaWrap® is a class II medical device that consists of a clear hydrogel plant-based sheet and a wetting solution provided in a dropper bottle. The wetting solution is applied to the sheet to render the sheet a gelatinous tissue adherent layer that separates target tissues from surrounding tissues to prevent unwanted postoperative tethering.

is a is a class II medical device, FDA cleared for use on tendon and peripheral nerves [54,55]. It is a bioresorbable hydrogel device made of polysaccharides alginate and hyaluronic acid designed to serve as an interface between target tissues and surrounding tissues to provide a non-constricting, protective encasement. The hydrogel sheet separates tissues, allowing tissue gliding, and preventing unwanted tethering during healing. The product is plant-based, transparent, flexible, ultrathin, non-sided, biocompatible, and can be implanted as a pre-formed sheet or as a gel, in situ.

The surgeon applied the hydrogel during posterior approach lumbar spine decompression surgery (Video 1, link to video) to manage scar tissue adhesion/tethering of the nerve root to the surrounding anatomy such as ligament, nerve, dura, bone, or other soft tissues. It is hypothesized that patients receiving the hydrogel in the initial procedure are expected to need less mechanical disruption of tissue during revision, if reoperation is needed.


Lumbar application of the hydrogel occurred during decompression surgeries at various levels (L1-S1). Lumbar decompression surgery (foraminotomy, laminectomy, discectomy) was performed using the minimally invasive tubular retraction (MITR) technique. The hydrogel sheet was cut into 1 cm x 1 cm squares, advanced through the tube, and placed on the peripheral nerve root and the adjacent dura, under the lamina of the spine (Figure 2).

Figure 2 Application of VersaWrap on nerve root in a decompression procedure: A) side view illustration, B) top view illustration, and C) top down photograph of applying VersaWrap sheet onto nerve root tissue; D) side view illustration, E) top view illustration, and F) top down photograph of applying VersaWrap solution to the implanted VersaWrap sheet. Conformance to underlying tissues is visually observed with application

Figure 2 Application of VersaWrap on nerve root in a decompression procedure: A) side view illustration, B) top view illustration, and C) top down photograph of applying VersaWrap sheet onto nerve root tissue; D) side view illustration, E) top view illustration, and F) top down photograph of applying VersaWrap solution to the implanted VersaWrap sheet. Conformance to underlying tissues is visually observed with application

In the event of a potential incidentaldurotomy during surgery, the hydrogel device was applied over the dura at the location of the durotomy.


Patient Demographics

One hundred sixty nine (169) patients met the inclusion criteria for the study. Demographics of the overall study population are included in Table 1.

Table 1: Demographics.

No. Patients

Gender (% F)

Mean Follow-up months (min-max)

Mean BMI


Mean EBL (cc)

Lumbar Decompression Patients


70/169 (41.4%)

9.5 (3-26)


19/169 (11.2%)


BMI: Body Mass Index, EBL: Estimated Blood Loss

Patient Reported Outcomes

Patient outcomes were collected as standard of care in the surgeon’s clinic. Patients reported statistically significant pain improvement in VAS back/leg (p<0.05), and significant functional improvement via ODI score (p<0.05) at all timepoints through 3-month follow-up when compared to baseline scores. (Figures 3 & 4).

Figures 3

Figure 3 Lumbar Decompression VAS Score. *p<0.05 using the paired  t-test to compare the change from baseline.

Figure 3 Lumbar Decompression VAS Score. *p<0.05 using the paired t-test to compare the change from baseline.

Figure 4

Figure 4 Lumbar Decompression ODI. *p<0.05, using the paired t-test  to compare the change from baseline.

Figure 4 Lumbar Decompression ODI. *p<0.05, using the paired t-test to compare the change from baseline.


There were four (4) peri-operative complications reported. The four (4) complications were reported as incidental durotomy, and the hydrogel was placed over the dura at the location of the tear. One of these patients required a reoperation (Table 2, Patient No. 22); a revision L5-S1 decompression at 17-months post-operative that was unrelated to the dural tear.

Reoperations: Opportunities for a second look

During data collection, there were eleven (11) patients that required a reoperation or secondary procedure that allowed visual confirmation of the effects of the hydrogel sheet. All reoperations were captured and evaluated for relatedness to the initial surgical indication; all reoperations were assessed by the operative surgeon and were deemed unrelated to the use of the hydrogel in the initial surgery. Reoperations occurring in the same anatomic region as the initial surgery are included in Table 2.

Table 2: Reoperations.



Initial surgery description (Levels)

Time to reoperation (months)

Reoperation Description



Lumbar decompression Left (L5-S1)



Revision decompression for recurrent disc herniation L5-S1 left side



Lumbar decompression Right (L4-L5)



Lumbar SCS implanted for continued pain



Lumbar decompression Left (L4-S1)



Revision decompression for recurrent disc herniation L5-S1 left side



Lumbar decompression Left (L4-L5)



Revision decompression for recurrent disc herniation L4-L5 left side



Lumbar decompression bilateral, right discectomy (L5-S1)




Lumbar SCS implanted for continued pain



Lumbar decompression Left (L5-S1)



Revision decompression for recurrent disc herniation L5-S1 left side



Lumbar decompression Right (L4-S1)



Revision decompression for recurrent disc herniation L4-S1 right side



Lumbar decompression Right (L5-S1)



Revision decompression for recurrent disc herniation L5-S1 right side



Lumbar decompression bilateral (L4-5)



Revision decompression for disc bulge and facet hypertrophy L3-L5 bilateral



Lumbar decompression bilateral (L4-5)



Revision decompression for recurrent disc herniation L4-L5 left side



Lumbar decompression Left (L5-S1)



Revision decompression for recurrent disc herniation L5-S1 right side

Abbreviations: SCS: Spinal Cord Stimulator.

The Intended function of the hydrogel is to allow postoperative tissue gliding such that there is reduced dural tearing during a reoperation.

Surgeon experience during reoperation was that the anatomy where the hydrogel had been placed was easily moved without significant mechanical disruption (Figure 6).

Figure 6 Reoperation VW used single side only during initial surgery.

Photographs and video were captured during three (3) reoperations in patients that received the hydrogel in their initial surgery.

Patient 09 received a bilateral laminectomy at L4-5 with placement of the hydrogel device, and a reoperation at 12 months for a revision bilateral laminectomy, also at L4-5, and new bilateral laminectomy at L3-4. (Figure 5)

Figure 6 Reoperation VW used single side only during initial surgery.

Figure 5 Reoperation L4-5 laminectomy with VW used during initial surgery

As expected, EF was present, however, more importantly, this fibrosis did not adhere the nerve root or peripheral nerve tissues to the adjacent dura and tissues were moved with ease.

Patient 10 received an initial L5-S1 fusion in 2002, with a prior surgeon and without the use of any adhesion barrier. An L4-5 left laminectomy was completed during this study, and the hydrogel was placed per the surgeon’s standard application. Thevideo and photos were captured during the left L4-5 laminectomy reoperation at 21 months postoperative. (Figure 6 & Video 2, link to video 2) The hydrogel was previously placed on the left side where the EF did not adhere to the adjacent dura, the EF is adhered on the right side where the prior surgeon did not place any adhesion barrier.

Figure 7

Figure 7 Reoperation L5-S1 decompression with hydrogel used  during initial surgery.

Figure 7 Reoperation L5-S1 decompression with hydrogel used during initial surgery.

and video 3 (link to video 3) represents a revision decompression for left L5-S1 recurrent disc herniation at 23 months postoperative (Patient 11). The operative surgeon indicated the presence of lightly tethered EF that was removed with ease.

Only one patient (Patient 03) experienced a complicationduring the reoperation. A minor focal incidental durotomy was noted when removing the scar tissue from the junction of S1 lamina and the dura. The durotomy was too small for a suture to be placed.


This 169-patient retrospective study is the first reported use of VersaWrap on nerve root in lumbar decompression procedures. The results suggest that it is safe and does not contribute to intraoperative or postoperative complication or adverse events out to 1 year postoperative.

Data from this retrospective study, using hydrogel as an adhesion barrier, indicate minimal incidence of dural tears when a secondary surgery was required. Only one patient (1/11=9%) experienced a small focal dural tear during a secondary surgery at or near the original surgical location. Other studies report an incidence of dural tears during secondary surgeries of the lumbar spine to be between 8.1% and 25% [17,56]. Dural tears reported during primary spine surgery trend lower (1%-13%) [17,57,58] as expected, given the absence of scar tissue.

Data from this study also indicate significant improvement in VAS back/leg pain for the MITR at 3-month follow-up. Given the past challenges in clinical trials utilizing the standard patient reported outcomes, such as VAS/ODI, it is understood that statistical significance does not necessarily correlate to the clinical significance of adhesion barriers. For clinical evaluation, Fransen’s report of visual inspection during reoperation remains a compelling endpoint [33].

This study reports no short- or long-term complications attributed to the use of the hydrogel when used in posterior lumbar decompression procedures. Other products report shortand long-term unexpected complications such as disturbance of muscle healing [38], however we did not note any such complications in this study. Furthermore, this study follow-up timepoint extended beyond those in other reports. While efficacy remains elusive with adhesion barriers, this data indicatesVersaWrap® is safe to use in these postoperative lumbar decompression procedures.

The surgeon noted during reoperations following use of the hydrogel that while some scar tissue was visible present, this tissue was easy to remove from adjacent tissues (Figures 5-7 and supplemental videos 2 & 3). The hydrogel is intended to allow opposed tissues to glide and to reduce the coefficient of friction between the nerve root and surrounding tissues, decreasing the detrimental effects of adhesions such as EF and dural tethering. The reduction of this unwanted tethering can lead to reduced complications during reoperation such as dural tearing. The prophylactic use of VersaWrap® in surgeries that carry a higher risk of reoperation should continue be explored further.


The clinical data presented here further the evidence supporting adhesion barriers during lumbar decompression surgery to mitigate the risks of scar tissue, EF, and adhesions that cause complications during reoperation. Patients receiving lumbar decompression reported significant improvement in pain and functional scores through 3-month follow-up with no reported complications related to the use of VersaWrap®. In the occurrence of reoperations, the surgeon reported less scar tissue adhesion, which reduced the need to mechanically disrupt adhesions where implanted.

There are limitations to this study, including that the data were retrospectively collected and primary endpoints for adhesion barrier studies in spine remain elusive. Adhesion barriers such as VersaWrap® should continue to be explored for more widespread use in spine surgery applications.


The authors have no conflict of interest that is directly related to the product in this manuscript.


The manuscript data collection and preparation was funded with an unrestricted grant from Alafair.


1. Mohi Eldin MM, Abdel Razek NM. Epidural fibrosis after lumbar disc surgery: Prevention and outcome evaluation. Asian Spine J. 2015; 9: 370-385.

2. LaRocca H, Macnab I. The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Jt Surg Br. 1974; 56B: 545-550.

3. Bosscher HA, Heavner JE. Incidence and severity of epidural fibrosis after back surgery: An endoscopic study. Pain Pract. 2010; 10: 18-24.

4. Manchikanti L, Singh V. Epidural Lysis of Adhesions and Myeloscopy. Curr Pain Headache Rep. 2002; 6: 427-435.

5. Clancy C, Quinn A, Wilson F. The aetiologies of Failed Back Surgery Syndrome: A systematic review. J Back Musculoskelet Rehabil. 2017; 30: 395-402.

6. Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine (Phila Pa 1976). 1983; 8: 131-140.

7. Brox JI, Reikerås O, Nygaard O, Sørensen R, Indahl A, Holm I, et al.Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: A prospective randomized controlled study. Pain. 2006; 122: 145-155.

8. Fritzell P, Nordwall A. Complications in lumbar fusion surgery for chronic low back pain?: comparison of three surgical techniques used in a prospective randomized study . A report from the Swedish Lumbar Spine Study Group. Eur Spine J. 2003; 12: 178-189.

9. Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JAH, Tans JTJ, et al. Surgery versus Prolonged Conservative Treatment for Sciatica. N Engl J Med. 2007; 356: 2245-2256.

10.Chan C, Peng P. Failed back surgery syndrome. Pain Med. 2011; 12: 577-606.

11.Annertz M, Jönsson B, Strömqvist B, Holtås S. No Relationship Between Epidural Fibrosis and Sciatica in the Lumbar Postdiscectomy Syndrome. Spine (Phila Pa 1976). 1995; 20: 449-553.

12.Coskin E, Suzer T, Topuz O, Zencir M, Pakdemirli E, Tahta K. Relationships between epidural fibrosis, pain, disability, and psychological factors after lumbar disc surgery. Eur Spine J. 2000; 9: 218-223.

13.Fritsch E, Heisel J, Rupp S. The Failed Back Surgery Syndrome: Reasons, Intraoperative Findings, and Long-term Results: A Report of 182 Operative Treatments. Spine (Phila Pa 1976). 1996; 21: 626-633.

14.Nachemson AL. Evaluation of results in lumbar spine surgery. Acta Orthop Scand. 1993; 251: 130-133.

15.Daniell JR, Osti OL. Failed back surgery syndrome: A review article. Asian Spine J. 2018; 12: 372-379.

16.Eichholz KM, Ryken TC. Complications of revision spinal surgery. Neurosurg Focus. 2003;15: 1-4.

17.Cammisa FPJ, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental Durotomy in Spine Surgery. Spine (Phila Pa 1976). 2000; 25: 2663-2667.

18.Ishikura H, Ogihara S, Oka H, Maruyama T, Inanami H, Miyoshi K, et al. Risk factors for incidental durotomy during posterior open spine surgery for degenerative diseases in adults: A multicenter observational study. PLoS One. 2017; 12: e018803.

19.Du JY, Aichmair A, Kueper J, Lam C, Nguyen JT, Cammisa FP, et al. Incidental durotomy during spinal surgery: a multivariate analysis for risk factors. Spine (Phila Pa 1976). 2014; 39: E1339-45.

20.Guerin P, El Fegoun AB, Obeid I, Gille O, Lelong L, Luc S, et al. Incidental durotomy during spine surgery: Incidence, management and complications. A retrospective review. Injury. 2012; 43: 397-401.

21.Kim SS, Michelsen CB. Revision Surgery for Failed Back Surgery Syndrome. Spine (Phila Pa 1976). 1992; 17: 957-960.

22.Jonsson B, Stromqvist B. Repeat decompression of lumbar nerve roots. A prospective two-year evaluation. J Bone Joint Surg Br. 1993; 75: 894-897.

23.North R, Campbell J, James C, Conover-Walker MK, Wang H, Piantadosi S, et al. Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation. Neurosurgery. 1991; 28: 685-690.

24.Tuijp SJ, Van Zundert J, De Vooght P, Puylaert M, Mestrum R, Heylen R, et al. Does the Use of Epiduroscopic Lysis of Adhesions Reduce the Need for Spinal Cord Stimulation in Failed Back Surgery Syndrome? A Short-Term Pilot Study. Pain Pract. 2018;18: 839-844.

25.Avellanal M, Diaz-Reganon G, Orts A, Gonzalez-Montero L, Riquelme I. Transforaminal Epiduroscopy in Patients with Failed Back Surgery Syndrome. Pain Physician. 2019; 22: 89-95.

26.Kallewaard JW, Vanelderen P, Richardson J, Van Zundert J, Heavner J, Groen GJ. Epiduroscopy for Patients With Lumbosacral Radicular Pain. Pain Pract. 2014;14: 365-377.

27.Anderson SR, Racz GB, Heavner J. Evolution of Epidural Lysis of Adhesions. Pain Physician. 2000; 3: 262-270.

28.SZABÓ G, MAGYAR S. Effect of Hyaluronidase on Capillary Permeability, Lymph Flow and Passage of Dye-Labelled Protein from Plasma to Lymph. Nature. 1958; 182: 377-399.

29.Baber Z, Erdek MA. Failed back surgery syndrome: Current perspectives. J Pain Res. 2016; 9: 979-987.

30.Temel SG, Ozturk C, Temiz A, Ersozlu S, Aydinli U. A New Material for Prevention of Epidural Fibrosis After Laminectomy Oxidized Regenerated Cellulose (Interceed), An Absorbable Barrier. J Spinal Disord Tech. 2006; 270-275.

31.Amirdelfan K, Webster L, Poree L, Sukul V, McRoberts P. Treatment Options for Failed Back Surgery Syndrome Patients with Refractory Chronic Pain: An Evidence Based Approach. Spine (Phila Pa 1976). 2017; 42: S41-S52.

32.Santos ERG, Goss DG, Morcom RK, Fraser RD. Radiologic Assessment of Interbody Fusion Using Carbon Fiber Cages. Spine (Phila Pa 1976). 2003; 28: 997-1001.

33.Fransen P. Safety of carboxymethylcellulose/polyethylene oxide for the prevention of adhesions in lumbar disc herniation - Consecutive case series review. Ann Surg Innov Res. 2008; 2: 2.

34.Wang H, Sun W, Fu D, Shen Y, Chen Y ying, Wang L-L. Update on biomaterials for prevention of epidural adhesion after lumbar laminectomy. J Orthop Transl. 2018; 13: 41-49.

35.Porchet F, Lombardi D, de Preux J, Pople I. Inhibition of epidural fibrosis with ADCONê-L: Effect on clinical outcome one year following re-operation for recurrent lumbar radiculopathy. Neurol Res. 1999; 21: S51-60.

36.Llado A, Guimera J, Garcia F, Navarro A. Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: an experimental study. Eur Spine J. 1999; 9: 138-143.

37.Wang B, Li P, Shangguan L, et al. A novel bacterial cellulose membrane immobilized with human umbilical cord mesenchymal stem cellsderived exosome prevents epidural fibrosis. Int J Nanomedicine. 2018;13: 5257-5273.

38.Kim SB, Lim YJ. Delayed detected unexpected complication of ADCON-L® gel in lumbar surgery. J Korean Neurosurg Soc. 2010; 48: 268-271.

39.Welch WC, Thomas KA, Cornwall GB, Gerszten PC, Toth JM, Nemoto EM, et al. Use of polylactide resorbable film as an adhesion barrier. J Neurosurg Spine. 2002; 97: 413-422.

40.Klopp LS, Toth JM, Welch WC, et al. Bioresorbable film for the prevention of adhesion to the anterior spine after anterolateral discectomy. Spine J. 2009;9: 411-417.

41.Klopp LS, Welch WC, Tai JW, Toth JM, Cornwall GB, Turner AS. Use of polylactide resorbable film as a barrier to postoperative peridural adhesion in an ovine dorsal laminectomy model. Neurosurg Focus. 2004;16: E2.

42.Sobti S, Grover A, S John Bp, Grewal S, George U. Prospective randomized comparative study to evaluate epidural fibrosis and surgical outcome in patients undergoing lumbar laminectomy withepidural autologous free fat graft or gelfoam: A preliminary study. Int J Appl Basic Med Res. 2018; 8: 71.

43.Wang K, Li X long, Liu J, Sun X, Yang H, Gao X. Using cross-linked hyaluronic acid gel to prevent postoperative lumbar epidural space adhesion: in vitro and in vivo studies. Eur Spine J. 2020; 29: 129-140.

44.Wang Y, Li L, Ma Y, Tang Y, Zhao Y, Li Z, et al. Multifunctional Supramolecular Hydrogel for Prevention of Epidural Adhesion after Laminectomy. ACS Nano. 2020; 14: 8202-8219.

45.Lei W, Ehmsen RJ, Chiacchierini RP, Krelle JL, Dizerega GS. Reduction of Leg Pain by Oxiplex Gel After Lumbar Discectomy in Patients With Predominant Leg Pain and Elevated Levels of Lower Back Pain A Prospective, Randomized, Blinded, Multicenter Clinical Study. J Spinal Disord Tech. 2013; 28: 301-307.

46.Liu ZC, Li Y, Zang Y, Cui G, Sang H-X, Ma Z-S, et al. Clinical assessment of a CMC/PEO gel to inhibit postoperative epidural adhesion formation after lumbar discectomy: A randomized, control study. Arch Orthop Trauma Surg. 2013; 133: 295-301.

47.Rhyne AL, Blumenthal SL, Frank EH, Hsu KY, Kim KD, Youssef JA, et al. Oxiplex Reduces Leg Pain, Back Pain, and Associated Symptoms After Lumbar Discectomy. Spine (Phila Pa 1976). 2012; 37: 631-641.

48.Rodgers KE, Robertson JT, Espinoza T, Oppelt W, Cortese S, diZerega GH, et al. Reduction of epidural fibrosis in lumbar surgery with Oxiplex adhesion barriers of carboxymethylcellulose and polyethylene oxide. Spine J. 2003; 3: 277-283.

49.Mayfield FH. Autologous Fat Transplants for the Protection and Repair of the Spinal Dura. Neurosurgery. 1980; 27: 349-361.

50.Assietti R, Mora A, Brayda-Bruno M. Use of Carboxymethylcellulose/ Polyethylene Oxide Gel in Microdiscectomy With Interlaminectomy. Spine (Phila Pa 1976). 2008; 33: 1762-1765.

51.SONGER MN, GHOSH L, SPENCER DL. Effects of Sodium Hyaluronate on Peridural Fibrosis After Lumbar Laminotomy and Discectomy. Spine (Phila Pa 1976). 1990; 15: 550-554.

52.Mayes SM, Davis J, Scott J, et al. Polysaccharide-based films for the prevention of unwanted postoperative adhesions at biological interfaces. Acta Biomater. 2020; 106: 92-101.

53.Nichols DS, Oberhofer H, Cox E, Chim H. Assessing the Use of the VersaWrap Nerve Protector in Patients with Upper Extremity Peripheral Neuropathies: A Prospective Case Series. In: American Society for Surgery of the Hand. 2021.

54.US Food and Drug Administration. VersaWrap Nerve Protector 510k.

55.US Food and Drug Administration. VersaWrap Tendon Protector 510k.

56.Smorgick Y, Baker KC, Herkowitz H, Montgomery D, Badve SA, Bachison C, et al. Predisposing factors for dural tear in patients undergoing lumbar spine surgery. J Neurosurg Spine. 2015; 22: 483- 486.

57.Wang JC, Bohlman HH, Daniel Riew K. Dural Tears Secondary to Operations on the Lumbar Spine MANAGEMENT AND RESULTS AFTER A TWO-YEAR-MINIMUM FOLLOW-UP OF EIGHTY-EIGHT PATIENTS*. 1998.

58.Yoshihara H, Yoneoka D. Incidental dural tear in spine surgery: Analysis of a nationwide database. Eur Spine J. 2014; 23: 389-394

Bruggeman A, Van Schouwen KF (2022) Results of a Bioresorbable Hydrogel Sheet Utilized as an Adhesion Barrier in Spine Surgery. JSM Neurosurg Spine 9(1): 1104.

Received : 21 Mar 2022
Accepted : 04 Apr 2022
Published : 07 Apr 2022
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X