Spinal Sealant System Provides Better Intraoperative Watertight Closure Than Standard of Care During Spinal Surgery

Wright, Neill M.; Park, Jon; Tew, John M.; Kim, Kee D.; Shaffrey, Mark E.; Cheng, Joseph; Choudhri, Haroon; Krishnaney, Ajit A.; Graham, Roger A.; Mendel, Ehud; Simmons, Nathan E.

doi:10.1097/brs.0000000000000810

Cited by 43 publications

(37 citation statements)

References 39 publications

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“…In the year of 2016, a low-swell PEG hydrogel as a modified form was developed. It showed a significantly higher rate of watertight closure than fibrin glue (98.6% vs. 79.2%) 12 . There still need more studies to assess its safety.…”

Section: Treatment Strategiesmentioning

confidence: 97%

“…A new treatment strategy has been proposed recently, which is to change the pressure difference to retard CSF leak. In this review, all treatment approaches were classified into two groups based on a fluid flow mechanics: 1) stopping CSF leak by direct suture or augmented closure with dural substitute material8, 9, 10, 11, 12, 13, 14, 15; 2) retarding CSF leak by reducing the subarachnoid fluid pressure and/or increasing the epidural space pressure 16, 17, 18, 19, 20, 21, 22, 23, 24…”

Section: Treatment Strategiesmentioning

confidence: 99%

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Treatment of cerebrospinal fluid leak after spine surgery

Zhao

Tian

Jia

et al. 2017

Chinese Journal of Traumatology

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Owing to the complexity of spinal surgery, there is a great prevalence of dural tear causing cerebrospinal fluid (CSF) leakage. Many studies focused on suture repair for dural tear to stop CSF leak. Now some new treatment strategies have shown a promising effect that is listed as follows: 1) creating watertight dural closure to stop CSF leak with the help of dural substitute material; and 2) retarding CSF leak by changing pressure difference, including reducing the subarachnoid fluid pressure, increasing the epidural space pressure and both. In fact several methods mentioned above are usually combined to treat CSF leak. However, no update review summarized the relevant studies implemented in recent years. In this review, the authors would compare the effects of different dural closure techniques, and introduce the latest treatment methods and mechanisms.

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Section: Treatment Strategiesmentioning

confidence: 97%

Section: Treatment Strategiesmentioning

confidence: 99%

Treatment of cerebrospinal fluid leak after spine surgery

Zhao

Tian

Jia

et al. 2017

Chinese Journal of Traumatology

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“…4,29,34,57 The manufacturer, Covidien, announced in 2011 that a new, low-swell formulation of the hydrogel dural sealant was approved by the FDA. Kim and Wright, 27 Osbun et al, 41 and Wright et al 64 concluded that the new DuraSeal product was superior to other standard-of-care methods to obtain a watertight dural closure and no neurological deficits were attributed to the sealant during spinal surgery. The incidence of neurosurgical complications, surgical-site infections, and CSF leaks using the hydrogel sealant was not statistically different from those observed with common dural sealing techniques.…”

Section: Adverse Effects Are Associated With Hydrogel Dural Sealant Umentioning

confidence: 99%

Effects of early surgical decompression on functional and histological outcomes after severe experimental thoracic spinal cord injury

Jalan

Saini

Zaidi

et al. 2017

SPI

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OBJECTIVE In acute traumatic brain injury, decompressive craniectomy is a common treatment that involves the removal of bone from the cranium to relieve intracranial pressure. The present study investigated whether neurological function following a severe spinal cord injury improves after utilizing either a durotomy to decompress the intradural space and/or a duraplasty to maintain proper flow of cerebrospinal fluid. METHODS Sixty-four adult female rats (n = 64) were randomly assigned to receive either a 3- or 5-level decompressive laminectomy (Groups A and B), laminectomy + durotomy (Groups C and D), or laminectomy + duraplasty with graft (Group E and F) at 24 hours following a severe thoracic contusion injury (200 kilodynes). Duraplasty involved the use of DuraSeal, a hydrogel dural sealant. Uninjured and injured control groups were included (Groups G, H). Hindlimb locomotor function was assessed by open field locomotor testing (BBB) and CatWalk gait analysis at 35 days postinjury. Bladder function was analyzed and bladder wall thickness was assessed histologically. At 35 days postinjury, mechanical and thermal allodynia were assessed by the Von Frey hair filament and hotplate paw withdrawal tests, respectively. Thereafter, the spinal cords were dissected, examined for gross anomalies at the injury site, and harvested for histological analyses to assess lesion volumes and white matter sparing. ANOVA was used for statistical analyses. RESULTS There was no significant improvement in motor function recovery in any treatment groups compared with injured controls. CatWalk gait analysis indicated a significant decrease in interlimb coordination in Groups B, C, and D (p < 0.05) and swing speed in Groups A, B, and D. Increased mechanical pain sensitivity was observed in Groups A, C, and F (p < 0.05). Rats in Group C also developed thermal pain hypersensitivity. Examination of spinal cords demonstrated increased lesion volumes in Groups C and F and increased white matter sparing in Group E (p < 0.05). The return of bladder automaticity was similar in all groups. Examination of the injury site during tissue harvest revealed that, in some instances, expansion of the hydrogel dural sealant caused compression of the spinal cord. CONCLUSIONS Surgical decompression provided no benefit in terms of neurological improvement in the setting of a severe thoracic spinal cord contusion injury in rats at 24 hours postinjury. Decompressive laminectomy and durotomy did not improve motor function recovery, and rats in both of these treatment modalities developed neuropathic pain. Performing a durotomy also led to increased lesion volumes. Placement of DuraSeal was shown to cause compression in some rats in the duraplasty treatment groups. Decompressive duraplasty of 3 levels does not affect functional outcomes after injury but did increase white matter sparing. Decompressive duraplasty of 5 levels led to neuropathic pain development and increased lesion volumes. Further comparison of dural repair techniques is necessary.

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“…Prevention is of great importance in managing CSF leakage complication. A watertight closure of the dura mater is crucial, and a direct suture with adjuvant dural closure material has gained popularity among spinal surgeons owing to its high successful rate in watertight closure [18,19]. At times the involved dura has been inevitably excised, and this renders a primary closure impossible.…”

Section: Csf Leakagementioning

confidence: 99%

Surgical Treatment of Benign Spinal Cord Tumors

Qi¹,

Shan²,

Feng³

et al. 2019

Cancer Immunotherapy and Biological Cancer Treatments

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Benign spinal cord tumors (SCTs) are uncommon neoplasms that can arise within or adjacent to the spinal cord. Depending on their anatomical location, benign SCTs can be categorized as intramedullary, intradural-extramedullary, and extradural. The three most common benign SCTs are meningioma, nerve sheath tumors, and ependymoma. Both meningioma and nerve sheath tumors develop in the intradural-extramedullary compartment, while ependymoma occurs in the intramedullary space. Spinal meningiomas derive from arachnoidal cells and most commonly occur within the thoracic segment of the spine. Nerve sheath tumors, including schwannomas and neurofibromas, are closely associated with spinal nerves. Half of the spinal cord ependymomas arise in the lumbosacral segment or the filum terminale. Surgical treatment of large or symptomatic benign SCTs concentrates on total or subtotal resection of the tumors, which should be cautiously individualized based on the tumor location and histopathology. A curable complete resection should be achieved if possible while preserving the nervous function of the spinal cord and minimizing potential complications. Thoracic spinal roots may be sacrificed to acquire a total resection, yet cervical and lumbar nerve roots should be preserved prudently. Due to the vulnerable and complex anatomic nature of the spinal cord, maximal resection of the tumors can be achieved with the aid of appropriate intraoperative neural monitoring and meanwhile preserve nervous function.

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Spinal Sealant System Provides Better Intraoperative Watertight Closure Than Standard of Care During Spinal Surgery

Abstract: 2.

Cited by 43 publications

References 39 publications

Treatment of cerebrospinal fluid leak after spine surgery

Treatment of cerebrospinal fluid leak after spine surgery

Effects of early surgical decompression on functional and histological outcomes after severe experimental thoracic spinal cord injury

Surgical Treatment of Benign Spinal Cord Tumors

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