The use of cranial aneurysm clips for repair of incidental lumbar durotomy: operative technique and case series.

BACKGROUND: Incidental durotomy is a common complication of posterior lumbar spine surgery, however effective and durable methods for primary repair remain elusive. Multiple existing techniques have previously been reported and extensively described including sutured repair and non-penetrating titanium clips. The use of cranial aneurysm clips for primary repair of lumbar durotomy serves as a safe and effective alternative to obtain watertight closure of a dural tear.

METHODS: We performed a retrospective review of patients at a single institution who underwent primary repair of an incidental lumbar durotomy with use of an aneurysm clip during open posterior lumbar surgery between 2012 and 2023. Patient demographics, operative details, and postoperative metrics were collected and examined to evaluate the safety and efficacy of the novel technique.

RESULTS: A total of 51 patients were included for analysis. Four patients underwent durotomy repair with aneurysm clip alone, 27 patients were repaired with aneurysm clip and fibrin glue, and 20 patients had repair with aneurysm clip, fibrin glue, and a collagen dural substitute. Three (5.9%) patients reported headaches, 2 (3.9%) with psuedomeningocele, and 1 (2%) with wound leakage. Two (3.9%) patients had treatment failure with return to OR for repair of CSF leak.

CONCLUSION: We report the largest series of patients undergoing primary repair of incidental durotomy with the use of an aneurysm clip. Utilization of an aneurysm clip is noted to be a safe, quick and effective method of primary repair when compared to existing repair techniques such as sutured repair or non-penetrating titanium clips.