Abstract
Background:Closure of the dura defect may be easy to perform in open lumbar surgery but could be difficult in minimally invasive transforaminal lumbar interbody fusions (MIS-TLIF) since MIS-TLIF was done through a small tube, which limited the use of standard dural repair instruments. We used nonpenetrating titanium clips that were originally designed for the vascular anastomoses to repair the dura defect, which is never described in the literature.Methods:We presented a case of spinal stenosis with incidental durotomy while performing MIS-TLIF. We closed the dura laceration with three medium-sized nonpenetrating titanium clips (AnastoClip Vessel Closure System, LeMaitre Vascular, Inc., Burlington, MA).Results:Nonpenetrating titanium clips have the benefits of being technically easy to use, reduced durotomy repair time, decreased bed rest due to related medical complications, superior postoperation with immediate hydrostatic strength, and better reapproximation if it fails to clip successfully. As for the postoperation follow up, clips are tiny and reveal no obvious artifact, especially in cases where the pedicle screws are already causing much artifact.Conclusion:Primary dural closure during MIS-TLIF with clips is an effective way in cases that involve limited tubular space.
Highlights
Closure of the dura defect may be easy to perform in open lumbar surgery but could be difficult in minimally invasive transforaminal lumbar interbody fusions (MIS‐TLIF) since MIS‐TLIF was done through a small tube, which limited the use of standard dural repair instruments
The neurologic sequelae of durotomy ranged from asymptomatic to pseudomeningocele, cerebrospinal fluid (CSF) fistula, and nerve root injury
Primary closure of the dura defect was considered the gold standard of durotomy management to prevent the neurologic sequelae
Summary
We presented a case of spinal stenosis with incidental durotomy while performing MIS‐TLIF. We closed the dura laceration with three medium‐sized nonpenetrating titanium clips (AnastoClip Vessel Closure System, LeMaitre Vascular, Inc., Burlington, MA). We used a small patty to press the bulging nerve root coming from the dura defect and put the edge of the dura defect together by using an atraumatic everting forceps. This allows for the dural edges to come together. After identifying that there was no nerve root present between the clip tips, we close the dura laceration with three medium‐sized nonpenetrating titanium clips (AnastoClip Vessel Closure System, LeMaitre Vascular, Inc., Burlington, MA) with 2‐mm gaps [Figure 1]. The wound was closed in a layered fashion without a subfacial drain
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