Durotomy repair in minimally invasive transforaminal lumbar interbody fusion by nonpenetrating clips

Cheng, Ya‐Fu; Lin, Ping‐Yi; Huang, Abel Po‐Hao; Cheng, Chun-Yuan; Chen, Chien‐Min; Hueng, Dueng‐Yuan

doi:10.4103/2152-7806.129161

Cited by 12 publications

(4 citation statements)

References 6 publications

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“…Non-penetrating titanium clamp: A non-penetrating titanium clip designed for vascular anastomosis is another option for DT[ 27 - 29 ]. Its clinical use does not produce pinholes, which solves the risk of CSF leakage caused by pinholes.…”

Section: Discussionmentioning

confidence: 99%

Late presentation of dural tears: Two case reports and review of literature

Chen¹,

Dong²,

Cheng³

et al. 2023

World J Clin Cases

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BACKGROUND The late presentation of dural tears (LPDT) has a low incidence rate and hidden symptoms and is easily ignored in clinical practice. If the disease is not treated in time, a series of complications may occur, including low intracranial pressure headache, infection, pseudodural cyst formation, and sinus formation. Here, we describe two cases of LPDT. CASE SUMMARY Two patients had sudden fever 1 wk after lumbar surgery. Physical examination showed obvious tenderness in the operation area. The patients were confirmed as having LPDT by lumbar magnetic resonance imaging and surgical exploration. One case was caused by continuous negative pressure suction and malnutrition, and the other was caused by decreased dural ductility and low postoperative nutritional status. The first symptom of both patients was fever, with occasional headache. Both patients underwent secondary surgery to treat the LPDT. Dural defects were observed and dural sealants were used to seal the dural defects, then drainage tubes were retained for drainage. After the operation, the patients were treated with antibiotics and the patients’ surgical incisions healed well, without fever or incision tenderness. Both recovered and were discharged 1 wk after the operation. CONCLUSION LPDT is a rare complication of spinal surgery or neurosurgery that has hidden symptoms and can easily be overlooked. Since it may cause a series of complications, LPDT needs to be actively addressed in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Late presentation of dural tears: Two case reports and review of literature

Chen¹,

Dong²,

Cheng³

et al. 2023

World J Clin Cases

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show abstract

“…5,12 Sutureless nonpenetrating titanium vascular anastomosis clips already use dural repair in open surgery, including minimally invasive spine surgery. 2 This clip application device is available in biportal endoscopic surgery. Compared with uniportal endoscopic surgery, techniques for biportal endoscopic spine use instruments for general spine operation as well as specialized endoscopic instruments.…”

Section: Discussionmentioning

confidence: 99%

“…Incidental durotomy is one of the common complications occurring during spine surgery. [1][2][3][4] Cerebrospinal fluid (CSF) leakage induces headache, nausea, intracranial hypotension, intracranial hemorrhage and pseudo-meningocele. 3 Moreover, CSF leak from durotomy leads to wound infection, meningitis, and neurologic deficit.…”

Section: Introductionmentioning

confidence: 99%

Repair of Incidental Durotomy Using Sutureless Nonpenetrating Clips via Biportal Endoscopic Surgery

Heo

Ha²,

Lee

et al. 2020

Global Spine Journal

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Study Design: Technical report. Objectives: Dural tear is one of the most common complications of endoscopic spine surgery. Although endoscopic dural repair of the durotomy area may be difficult, we successfully repaired the dural tear area using nonpenetrating clips during biportal endoscopic surgery. We introduce the surgical technique of dural repair using nonpenetrating titanium clips in biportal endoscopic spine surgery and report its clinical outcome. Methods: We retrospectively reviewed and analyzed 5 patients who were treated via primary dural repair using nonpenetrating titanium clips during biportal endoscopic lumbar surgery. The 2 methods of dural clipping and repair include 2 or 3 portals. We analyzed radiological parameters such as cerebrospinal fluid collection as well as clinical parameters, including postoperative clinical outcomes. Results: Five patients underwent biportal endoscopic dural repair using nonpenetrating clips. Incidental durotomy was successfully repaired using nonpenetrating titanium clips in all 5 patients. No cerebrospinal fluid collection was detected in the postoperative magnetic resonance images. Clinically, preoperative symptoms improved significantly after surgery ( P < .05). Conclusions: We repaired the dural tear area completely using nonpenetrating titanium vascular anastomosis clips in biportal endoscopic lumbar surgery. Dural repair via clipping method may be an effective alternative for incidental durotomy.

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“…[31][32][33][34] It has demonstrated efficacy for use in major vascular injuries in skull base surgery and has recently been approved for dural reconstruction for its potential in preventing postoperative CSF leaks. 6,35 Thus far, there is evidence that the clips can be used to repair leaks in the spinal dura, [36][37][38][39] as well as one case report that demonstrated the use of titanium clips in repairing a CSF leak at the skull base. 40 Skull base repairs often fail at the leading edge of the graft.…”

Section: Discussionmentioning

confidence: 99%

Failure Pressures of Dural Repairs in a Porcine Ex Vivo Model: Novel Use of Titanium Clips Versus Tissue Glue

Chorath

Krysinski

Bunegin

et al. 2019

Allergy�Rhinol (Providence)

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ObjectiveEndoscopic skull base surgery is advancing, and it is important to have reliable methods to repair the resulting defect. The objective of this study was to determine the failure pressures of 2 commonly used methods to repair large dural defects: collagen matrix underlay with fibrin glue and collagen matrix underlay with polyethylene glue, as well as a novel repair method: fascia lata with nonpenetrating titanium vascular clips.MethodsThe failure pressure of the 3 dural repairs was determined in a closed testing apparatus. Defects in porcine dura were created and collagen matrix grafts were used as an underlay followed by either fibrin glue (FG/CMG) or polyethylene glycol glue (PEG/CMG). A third condition using a segment of fascia lata was positioned flush with the edges of the dural defect and secured with titanium clips (TC/FL). Saline was infused to simulate increasing intracranial pressure (ICP) applied to the undersurface of the grafts until the repairs failed.ResultsThe mean failure pressure of the PEG/CMG repair was 34.506 ± 14.822 cm H2O, FG/CMG was 12.413 ± 5.114 cm H2O, and TC/FL was 8.330 ± 3.483 cm H2O. There were statistically significant differences in mean failure pressures among the 3 repair methods.ConclusionIn this ex vivo model comparing skull base repairs’ ability to withstand cerebrospinal fluid leak, the repairs that utilized PEG/CMG tolerated the greatest amount of pressure and was the only repair that exceeded normal physiologic ICP’s. Repair methods utilizing glues generally tolerated higher pressures compared to the novel repair using clips alone.

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Durotomy repair in minimally invasive transforaminal lumbar interbody fusion by nonpenetrating clips

Cited by 12 publications

References 6 publications

Late presentation of dural tears: Two case reports and review of literature

Late presentation of dural tears: Two case reports and review of literature

Repair of Incidental Durotomy Using Sutureless Nonpenetrating Clips via Biportal Endoscopic Surgery

Failure Pressures of Dural Repairs in a Porcine Ex Vivo Model: Novel Use of Titanium Clips Versus Tissue Glue

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