SPINEVolume29,Number24,pp2861–2867©2004,LippincottWilliams&Wilkins,Inc.CollagenMatrix(DuraGen)inDuralRepair:AnalysisofaNewModifiedTechniquePradeepK.Narotam,MB,ChB,MMED,FCS(SA),FRCSC,FACS,SunilJose´,MBBS,NarendraNathoo,MB,ChB,PhD,FCS,CharlesTaylon,MD,andYashailVora,MD,FRCSCStudyDesign.Retrospectivereviewof110patientsundergoingspinalduralrepairandregenerationusinganonlay,suture-free,3-dimensional-collagenmatrixgraft(DuraGen)overan8-yearperiod(1995–2003).Objectives.Techniqueappraisalofcollagenmatrixtorepairspinaldurafollowingincidentaldurotomy,spinaltumorsurgery,andtrauma.SummaryofBackgroundData.Traditionalmethodsofspinalduralrepairfollowingincidentaldurotomyinvolvetediousattemptsatprimarywatertightsuturewitha5%to10%failurerate.Duralinjuryoccursaftertrauma,orduralexcisionmayberequiredaftertumorresection.Collagenmatrixisanewerdevelopmentincollagensponge.Methods.Theclinicalanddemographicdataincludeddiagnosis,typeandsiteofsurgery,infectionrisk,sizeofdefect,useoflumbardrains,closedsuctionsubfascialdrains,andadverseevents.Theprimaryendpointsofgraftfailurewerecerebrospinalfluidleakandpseudome-ningoceleformation.Neurosurgicalwoundinfectionratesweredetermined.Results.Collagenmatrixwasused(n�110)inthefollowingconditions:degenerative(69),pseudomeningo-celeformationrepair(4),tumors(14),trauma(13),andcongenital(5).Therewere15cervical(10anterior),21thoracic(3anterior),and71lumbar(allposterior)surger-ies.Fibringluewasusedin7.3%,subfascialdrainsin82%,andlumbardrainagein2.7%.Overall,cerebrospinalfluidleaksoccurredin2.7%.The2pseudomeningoceleformations(3.2%)resolvedat3months.Therewere2woundinfections.Inthesubgroupwithincidentaldu-rotomy(n�69),failureofcerebrospinalfluidcontain-mentoccurredin4.3%[1cerebrospinalfluidleak(1.4%),2pseudomeningoceleformations(2.9%)].Conclusions.Collagenmatrixwassuccessfulincere-brospinalfluidcontainmentin�95%ofpatientsrequir-ingduralrepairfollowinganteriorandposteriorspinalsurgery.Subfascialdrainsweresafe.Routinelumbardrainsarenotrequiredbutarereco...
