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European Spine Journal
Published in: European Spine Journal 8/2014

Open Access 01-08-2014 | Original Article

The use of surgical sealants in the repair of dural tears during non-instrumented spinal surgery

Authors: Massimo Miscusi, Filippo Maria Polli, Stefano Forcato, Maria Antoaneta Coman, Luca Ricciardi, Alessandro Ramieri, Antonino Raco

Published in: European Spine Journal | Issue 8/2014

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Abstract

Purpose

To compare the success in repair of dural tears (DTs) using two different surgical sealants in non-instrumented lumbar spinal surgery and evaluate the incidence of associated short- and long-term complications.

Methods

Twenty-three patients undergoing non-instrumented spinal surgery with intraoperative DTs were included both retrospectively and prospectively in this study. External signs of CSF leakage, neurological deficits, and infection-related complications were investigated postoperatively. The persistence of low-back pain was also evaluated and postoperative MRI was performed in all patients. DTs were repaired intraoperatively using suture with or without a dural patch. Eleven patients received an application of fibrin glue (Tissucol®; Baxter, Inc., IL, USA) and 12 patients received an application of bovine serum albumin glutaraldehyde surgical adhesive (BioGlue® Surgical Adhesive; CryoLife, GA, USA). These patients were followed up at 3 months and 1 year postoperatively.

Results

Successful intraoperative DT repair was obtained in all cases. Three patients in the Tissucol group presented with CSF leakage in the early postoperative period. There were no complications observed in the patients treated with BioGlue. At 3-month follow-up, no incidences of neurological or infection-related complications were observed in either group. There was no statistically significant difference in VAS between the two treatment groups.

Conclusions

Intraoperative DTs can be easily repaired by many effective techniques. However, in our experience, the use of BioGlue is an effective adjunct to immediate dural repair, being comparable in terms of efficacy and safety to the use of fibrin glue, potentially decreasing the incidence of associated short- and long-term complications.
Literature
1.
Bosacco SJ, Gardner MJ, Guille JT (2001) Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res 389:238–247PubMedCrossRef
2.
3.
Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS (2000) Incidental durotomy in spine surgery. Spine 25:2663–2667PubMedCrossRef
4.
Carmouche JJ, Molinari RW (2004) Epidural abscess and discitis complicating instrumented posterior lumbar interbody fusion: a case report. Spine 29:E542–E546PubMedCrossRef
5.
Epstein NE (2007) The frequency and etiology of intraoperative dural tears in 110 predominantly geriatric patients undergoing multilevel laminectomy with noninstrumented fusions. J Spinal Disord Tech 20:380–386PubMedCrossRef
6.
7.
Jones AA, Stambough JL, Balderston RA, Rothman RH, Booth RE Jr (1989) Long-term results of lumbar spine surgery complicated by unintended incidental durotomy. Spine 14:443–446PubMedCrossRef
8.
Khan MH, Rihn J, Steele G, Davis R, Donaldson WF 3rd, Kang JD et al (2006) Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine 31:2609–2613PubMedCrossRef
9.
Saxler G, Krämer J, Barden B, Kurt A, Pforter J, Bernsmann K (2005) The long-term clinical sequelae of incidental durotomy in lumbar disc surgery. Spine 30:2298–2302PubMedCrossRef
10.
Sin AH, Caldito G, Smith D, Rashidi M, Willis B, Nanda A (2006) Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery. J Neurosurg Spine 5:224–227PubMedCrossRef
11.
Stolke D, Sollmann WP, Seifert V (1989) Intra- and postoperative complications in lumbar disc surgery. Spine 14:56–59PubMedCrossRef
12.
Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80:1728–1732PubMedCrossRef
13.
Black P (2002) Cerebrospinal fluid leaks following spinal surgery: use of fat grafts for prevention and repair. Technical note. J Neurosurg 96(Suppl 2):S250–S252
14.
Boogaarts JD, Grotenhuis JA, Bartels RH, Beems T (2005) Use of a novel absorbable hydrogel for augmentation of dural repair: results of a preliminary clinical study. Neurosurgery 57(Suppl 1):S146–S151 (discussion S146–S151)CrossRef
15.
Hawk MW, Kim KD (2000) Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus 9:E5PubMedCrossRef
16.
Hida K, Yamaguchi S, Seki T, Yano S, Akino M, Terasaka S et al (2006) Nonsuture dural repair using polyglycolic acid mesh and fibrin glue: clinical application to spinal surgery. Surg Neurol 65:136–142 (discussion 142–143)PubMedCrossRef
17.
Hughes SA, Ozgur BM, German M, Taylor WR (2006) Prolonged Jackson-Pratt drainage in the management of lumbar cerebrospinal fluid leaks. Surg Neurol 65:410–414PubMedCrossRef
18.
Nakamura H, Matsuyama Y, Yoshihara H, Sakai Y, Katayama Y, Nakashima S et al (2005) The effect of autologous fibrin tissue adhesive on postoperative cerebrospinal fluid leak in spinal cord surgery: a randomized controlled trial. Spine 30:E347–E351PubMedCrossRef
19.
Le AX, Rogers DE, Dawson EG, Kropf MA, De Grange DA, Delamarter RB (2001) Unrecognized durotomy after lumbar discectomy: a report of four cases associated with the use of ADCON-L. Spine 26:115–117PubMedCrossRef
20.
Eismont FJ, Wiesel SW, Rothman RH (1981) Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am 63:1132–1136PubMed
21.
Goodkin R, Laska LL (1995) Unintended “incidental” durotomy during surgery of the lumbar spine: medicolegal implications. Surg Neurol 43:4–12 (discussion 12–14)PubMedCrossRef
22.
Hodges SD, Humphreys SC, Eck JC, Covington LA (1999) Management of incidental durotomy without mandatory bed rest. A retrospective review of 20 cases. Spine 24:2062–2064PubMedCrossRef
23.
24.
25.
26.
Klimo P Jr, Khalil A, Slotkin JR, Smith ER, Scott RM, Goumnerova LC (2007) Wound complications associated with the use of bovine serum albumin-glutaraldehyde surgical adhesive in pediatric patients. Neurosurgery 60(Suppl 2):S305–S309 (discussion 309) CrossRef
27.
Fürst W, Banerjee A (2005) Release of glutaraldehyde from an albumin-glutaraldehyde tissue adhesive causes significant in vitro and in vivo toxicity. Ann Thorac Surg 79:1522–1528 (discussion 1529)PubMedCrossRef
28.
Stylli SS, Kumar A, Gonzales M, Kaye AH (2004) The biocompatibility of BioGlue with the cerebral cortex: a pilot study. J Clin Neurosci 11:631–635PubMedCrossRef
29.
Kumar A, Maartens NF, Kaye AH (2003) Evaluation of the use of BioGlue® in neurosurgical procedures. J Clin Neurosci 10:661–664PubMedCrossRef
30.
Dusick JR, Mattozo CA, Esposito F, Kelly DF (2006) BioGlue for prevention of postoperative cerebrospinal fluid leaks in transsphenoidal surgery: a case series. Surg Neurol 66:371–376 discussion 376PubMedCrossRef
31.
Sen A, Green KM, Khan MI, Saeed SR, Ramsden RT (2006) Cerebrospinal fluid leak rate after the use of BioGlue in translabyrinthine vestibular schwannoma surgery: a prospective study. Otol Neurotol 27:102–105PubMedCrossRef
32.
Miscusi M (2004) Initial experience of a new surgical adhesive (BioGlue) in neurosurgery. In: XIX biennial Congress of the European Society of Pediatric Neurosurgery. Rome 6–9 May 2004
Metadata
Title
The use of surgical sealants in the repair of dural tears during non-instrumented spinal surgery
Authors
Massimo Miscusi
Filippo Maria Polli
Stefano Forcato
Maria Antoaneta Coman
Luca Ricciardi
Alessandro Ramieri
Antonino Raco
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 8/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-013-3138-1

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