Effectiveness of Repair Techniques for Spinal Dural Tears: A Systematic Review.

Abstract Background Incidental or intentional durotomy in spine surgery is associated with a risk of cerebrospinal fluid (CSF) leakage and reoperation. Several strategies have been introduced but the incomplete closure is still relatively frequent and troublesome. In this study, we review current evidence on spinal dural repair strategies and evaluate their efficacy. Methods PubMed, Web of Science and Scopus were used to search primary studies about the repair of the spinal dura with different techniques. Of 265 articles found, 11 studies, which specified repair techniques and post-operative outcomes, were included for qualitative and quantitative analysis. The primary outcomes were CSF leakage and post-operative infection. Results The outcomes of different dural repair techniques were available in 776 cases. Pooled analysis of 11 studies demonstrated that the most commonly used technique was a combination of primary closure, patch or graft and sealant (22.7%, 176/776). A combination of primary closure and patch or graft resulted in the lowest rate of CSF leakage (5.5%, 7/128). In this study, sealants as an adjunct to primary closure (13.7%, 18/131) did not significantly reduce the rate of CSF leakage compared to primary closure alone (17.6%, 18/102). The rates of infection and postoperative neurological deficit were similar regardless of the repair techniques. Conclusions Although the use of sealants has become prevalent, available sealants as an adjunct to primary closure did not reduce the rate of CSF leakage compared to primary closure. The combination of primary closure and patches or grafts could be effective in decreasing postoperative CSF leakage.