Durability of Intraoperative Fibrin-Coated Collagen Patch and Vascularized Muscle Flaps for Spinal Cerebrospinal...

Incidental dural tears occur in 1.6% to 17% of spinal procedures and may lead to complications including cerebrospinal fluid (CSF) leaks, pseudomeningocele, and meningitis. While primary suture repair remains the standard approach, failure rates range from 5% to 9%. This study evaluates fibrin-coated collagen patches combined with paraspinal muscle flaps for managing dural tears during spine surgery.

A retrospective review of prospectively collected cases was conducted at a single institution. Patients with intraoperative dural tears repaired using fibrin-coated collagen patch and paraspinal muscle flaps between February 2023 and July 2025 were included. Dural defects were repaired by placing a fibrin-coated collagen patch over the tear, buttressed with a vascularized paraspinal muscle flap. The primary outcome was failure of the initial dural repair, defined as postoperative CSF leak requiring reoperation. Secondary outcomes included wound complications, meningitis, pseudomeningocele, and hematoma formation.

Eight patients with a median age of 69 years (63% female) underwent dural repair across a median of 4 spinal levels (range, 2-8 levels). No patients developed wound infections or required reoperation related to dural repair. Median follow-up was 18 months (IQR, 16-21 months; range, 7-27 months). One patient had a low-pressure positional headache that resolved during the hospital stay.

In this cohort, fibrin-coated collagen patches provided effective dural closure without primary suture repair. When reinforced with paraspinal muscle flaps, this approach offers an efficient alternative to traditional primary closure. This preliminary series supporting technical feasibility warrants larger comparative studies to establish its long-term efficacy and generalizability.