Nonsuture dural repair using polyglycolic acid mesh and fibrin glue: clinical application to spinal surgery

概要

論文の詳細を見る
Background: In spinal surgery, repair of the dura is difficult when it is torn, fragile, or is ossifiedas in cases with OPLL. We report our experience with a non-suture dural repair technique inpatients undergoing spinal surgery; it employs a dura substitute composed of polyglycolic acid(PGA) mesh and fibrin glue. Here we report the efficacy and safety of non-suture duroplastyusing PGA mesh and fibrin glue (PGA-fibrin sheet).Methods: The artificial dura mater is composed of a PGA-fibrin sheet. The dural defect iscovered with a patch sprayed with fibrin glue without suturing to the dura mater. We firstevaluated this technique in an experimental study by performing water leakage tests. BetweenMay 2001 and January 2005 we used it in 160 spinal surgeries that required intraoperative durarepair.Results: Our preliminary tests showed that the threshold for water pressure without leakage was161 ± 42 mmHg and 96.5 ± 32 mmHg when the unsprayed margin around the perimeter of thepatch was 5 mm and 2 mm, respectively. Of the 160 operated patients, 10 (6.3%) experiencedsubcutaneous CSF leakage. Of these, 6 required a second operation, in the other 4 the CSFcollection diminished spontaneously. There were no other complications such as allergic reaction,adhesion, or infection.Conclusion: In combination with CSF diversion, the PGA-fibrin sheet is a viable alternativemethod for dural repair in spinal surgery.
Elsevier Incの論文