3. Assessment of in vitro dural repair techniques with a hydrostatic pressure device

• Published in: The spine journal 2022-09, Vol.22 (9), p.S2-S2
• Main Authors: Ahorukomeye, Peter, Furey, Christopher G.
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2022.06.017

Incidental durotomies are a relatively infrequent occurrence during lumbar spine surgery and are generally benign, without significant adverse consequences. Treatment with direct repair, with or without augmentation, is generally very effective and further cerebrospinal fluid (CSF) leak is uncommon. The strength and stability of a dural repair is dependent on several factors, including patient age, quality of dural tissue, the size and location of the durotomy, and the manner in which the repair is performed. There is limited in vitro evidence comparing the strength of different dural repair techniques and the resulting likelihood of recurrent CSF leak. To compare the strength and stability of various dural repair techniques in an in vitro human cadaveric durotomy model. An in vitro testing device was created to apply controlled, hydrostatic pressure to evaluate the integrity of a surgically-created durotomy. Sixteen human cadaveric specimens. The hydrostatic pressure required to cause a leak at the site of the dural repair. Complete human cadavers were placed in the prone position and the dura in the thoracic and lumbar spines was exposed through a midline incision and subsequent laminectomies. The dura was clamped 8 cm proximal and distal to the level of the durotomy and clamped with reliable, water-tight plastic rings. A 16-gauge plastic catheter was introduced into the lateral aspect of the dura and sutured in a water-tight fashion to serve as the source for instilling saline into the dura. The catheter was attached to a hydrostatic pressure measuring column to assess the intradural pressure. Linear durotomies of either 1 cm or 6 cm in length were made with a 15 blade in both the thoracic and lumbar spines of each cadaver. A dural repair was performed with either a 6-0 prolene or 2-0 silk suture. Repair technique were either multiple, simple interrupted sutures or a simple running repair with knots at the respective margins of the durotomy. An analysis of variant analysis (ANOVA) was employed to assess differences in leak rates with respect to applied hydrostatic pressure. Eight repair groups (thoracic vs lumbar / 6-0 prolene vs 2-0 silk / running vs multiple interrupted) were studied for each of the 1 cm and 6 cm durotomies. There were no significant differences noted in the frequency or extent of spinal fluid leak at different hydrostatic pressures with respect to either suture type employed or suture technique performed. There was a slight differenc