Pressure-modulated dural repair during unilateral biportal endoscopic spine surgery: technique description and preliminary feasibility report

The clinical management of incidental durotomy during the performance of endoscopic spine surgery presents a significant clinical challenge. Instrument maneuverability is limited, and the unique aqueous environment that introduces complications secondary to the intradural influx of irrigation fluid. The purpose of this study was twofold: first, to describe in detail a novel water-pressure modulation technique for collagen matrix inlay graft placement for incidental durotomy repair during unilateral biportal endoscopic spine surgery (UBES); and second, to evaluate the efficacy of this technique in three specific clinical cases, focusing on its feasibility and safety.

This retrospective study was conducted on clinical cases involving patients who underwent UBES for degenerative lumbar spine pathology from September 2022 to September 2024, based on a review of medical records. Surgical documentation was rigorously examined to ascertain occurrence of incidental durotomy during UBES. The clinical characteristics associated with the durotomy were systemically documented alongside the specific repair technique employed.

A total of three incidental durotomies were identified from 91 UBES procedures performed, resulting in an incidence rate of 3.29%. In each case, the incidental durotomy was successfully repaired through the modulation of irrigation pressure to facilitate the placement of a collagen matrix inlay graft. No patients experienced postoperative cerebrospinal fluid leak or required revision surgery.

Analysis of these clinical cases demonstrated the technical feasibility and preliminary safety of irrigation pressure modulation for collagen matrix inlay graft placement for incidental durotomy repair during UBES. However, further studies with a larger sample size are required to confirm these findings.