Enhanced technique of dural closure using autologous fat graft and Gelfoam for effective management of dural tear following interlaminar endoscopic lumbar spine surgery

• Published in: European spine journal Vol. 33; no. 7; pp. 2886 - 2891
• Main Authors: Pruttikul, Pritsanai, Sutthiwongkit, Thanat, Kunakornsawat, Sombat, Paiboonsirijit, Sompoch, Pongpirul, Krit
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2024; Springer Nature B.V
• Subjects: Adipose Tissue - surgery; Adipose Tissue - transplantation; Adult; Aged; Back surgery; Bone surgery; Case Report; Cerebrospinal fluid; Decompression; Decompression, Surgical - adverse effects; Decompression, Surgical - methods; Diskectomy - adverse effects; Diskectomy - methods; Dura Mater - injuries; Dura Mater - surgery; Endoscopy; Endoscopy - methods; Female; Gelatin Sponge, Absorbable - therapeutic use; Humans; Injuries; Lumbar Vertebrae - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Patients; Postoperative Complications - etiology; Postoperative Complications - surgery; Reconstructive surgery; Spinal Stenosis - surgery; Spine (lumbar); Stenosis; Surgical Orthopedics; Wound healing; Dural tear; Interlaminar endoscopic lumbar spine surgery; Dural closure; Dural repair
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-024-08262-1

Background Incidental dural tears are common complications in lumbar spine surgery, particularly in endoscopic procedures where primary closure via suturing is challenging. The absence of a standardized approach for dural closure in endoscopic spine surgery necessitates exploring alternative techniques. Objective This study introduces a surgical technique for dural closure utilizing fat graft and Gelfoam, offering an effective alternative to standard approaches in endoscopic spine surgery. Methods Surgical data from patients who underwent interlaminar endoscopic discectomy or stenosis decompression at Lerdsin Hospital from October 2014 to October 2021 were analyzed. Results Among 393 cases, dural tears occurred in 2% (8 patients). Our technique achieved successful closure in all these cases, with no incidents of cerebrospinal fluid leakage or wound complications. The majority of patients showed favorable clinical outcomes, except for one case involving concomitant nerve root injury. Conclusion This study demonstrates that using fat graft and Gelfoam for dural closure is a simple, reliable, and safe technique, particularly effective for challenging-to-repair areas in interlaminar endoscopic lumbar spine surgery.