Magnetic Resonance Imaging Signal Characteristics of Medishield: Early Postoperative Profile in a Rabbit Interlaminotomy Model

World Neurosurg. 2017 Feb:98:704-710.e3. doi: 10.1016/j.wneu.2016.12.002. Epub 2016 Dec 10.


Objective: Application of Medishield to the nerve root is common during spinal surgery to create a mechanical barrier from pain mediators and reduce scar formation. However, Medishield's signal characteristics on magnetic resonance imaging (MRI) have not yet been examined.

Methods: Microsurgical interlaminotomy was performed on 2 lower lumbar segments in 17 adult New Zealand white rabbits. After dural exposure, applications of 1 mL (autologous blood clot or Medishield) were randomized for each level. On postoperative days 1 through 3, various MRI sequences in 1.5T were performed including T1-weighted, T2-w, T1-gadolinium-weighted, susceptibility-weighted and turbo inversion recovery magnitude (TIRM) sequence. Signaling characteristics were analyzed by 3 blinded observers. Inter-rater agreement was calculated using Fleiss's kappa coefficient (κ). Positive and negative likelihood ratios in detecting Medishield by MRI were determined.

Results: Of 24 MRIs performed, TIRM sequence identified Medishield with the highest likelihood ratio. Medishield's positive likelihood ratio was highest (5.8) on postoperative day 1 with interobserver agreement of 93% (κ = 0.75); these rates declined to 2.5 and 1.4 on postoperative days 2 and 3 with interobserver agreements of 71% (κ = 0.43) and 83% (κ = 0.67), respectively. Medishield adherence was confirmed in each rabbit by histologic examinations.

Conclusion: Understanding that radiologic detection of Medishield diminished over time as its signal characteristics became less distinguishable from a blood clot is essential in clinical practice. Medishield was detected on postoperative day 1 but not 2 days later after hemodynamic changes had occurred. These results may provide a guide for postoperative findings, such as differential diagnosis of hematoma.

Keywords: Animal model; Interlaminotomy model; Lumbar disk disease; Magnetic resonance imaging; Medishield; New Zealand white rabbit; Postoperative fibrosis.

MeSH terms

  • Animals
  • Cicatrix / prevention & control
  • Disease Models, Animal
  • Female
  • Laminectomy / methods*
  • Lumbar Vertebrae / surgery*
  • Magnetic Resonance Imaging
  • Microsurgery / methods*
  • Organ Sparing Treatments / methods*
  • Postoperative Period
  • Rabbits
  • Trauma, Nervous System / prevention & control