Inhibition Of Tumor Necrosis Factor May Improve Wound Healing And Reduce Scar Formation Following Laminectomy. A Pilot Study In Pigs.

In rats treated with a selective TNF-inhibitor it was accidentally found that wound healing was improved and scar/adhesion formation was reduced. The present pilot study was performed to evaluate if this could be repeated in a controlled setting using a laminectomy model in the pig. Following anesthesia a laminectomy of all sacral vertebrae was performed in 6 pigs. Three pigs were treated with infliximab (a selective TNF inhibitor) and three pigs received saline and served as control. After 7 days the laminectomy site was evaluated by a macroscopical analysis and specimens of skin and muscle tissue over the laminectomy were processed for histology. Skin, fascia, muscle and bone healing was remarkably better in the pigs treated with infliximab. In pigs treated with infliximab there were signs of a partial healing of the laminectomy defect and in the centre of the defect there was a gel-like tissue that allowed for observation of the underlying nervous tissues. The laminectomy defect in saline treated animals had less bone formation and a soft scar in the centre of the defect. The present pilot investigation may thus indicate that an inhibition of pro-inflammatory cytokines may increase wound-healing rate and reduce scar formation/adhesion. However, further studies that evaluate exact mechanisms, when and how long to use anti-inflammatory treatment, long term effects, wound quality, risks for infection, if this may be translated to humans, must be undertaken before any conclusions regarding a clinical use may be drawn. The study nevertheless implies that it might be possible to develop a biological agent that alone or in combination with a mechanical barrier may reduce epidural scarring following spinal surgery.