Efficacy of patch technique for dural tear repair using hydrogel sealant: a pilot study

Abstract

BACKGROUND CONTEXTDural tear is one of the common complications of lumbar spine surgery. Suture repair is often difficult due to the requirement of meticulous suture technique in limited space. Dural tear repair is particularly challenging in minimally invasive spine surgery. The patch technique, applying patch material and glue without suture, is an alternative method for dural tear repair. PURPOSETo verify the efficacy of patch technique for dural tear repair using polyethylene glycol hydrogel sealant and to compare patch materials. STUDY DESIGN/SETTINGBasic research. METHODSThere were three study groups: Group 1 (control group, n=4) had hydrogel sealant alone, Group 2 (n=8) had collagen sheet patch and hydrogel sealant, Group 3 (n=8) had mesh sheet patch and hydrogel sealant. A 4-mm durotomy was made in a piece of bovine dura using an arterial punch. Patch material (collagen or mesh sheet) was placed over the dural tear with 2 mm margin and then sprayed with hydrogel sealant. The pressure in the system was increased by 10 mm Hg and monitored. When the leakage occurred, the pressure threshold was measured. RESULTSThe mean pressure threshold for leakage was 32.5 (Standard deviation=15.0), 66.3 (37.0), and 88.8 (27.5) mm Hg for Group 1, 2 and 3, respectively. The mean pressure threshold for leakage for Group 3 was significantly higher than that for Group 1 (p<.05). There was no significant difference in the mean pressure threshold for leakage between Groups 1 and 2, and Groups 2 and 3. CONCLUSIONSPatch technique using mesh sheet and hydrogel sealant demonstrated significantly higher mean pressure threshold for leakage compared with hydrogel sealant alone. CLINICAL SIGNIFICANCEPatch technique using mesh sheet and hydrogel sealant without suture is potentially a reasonable option for dural tear repair in lumbar spine surgery.