Collagen matrix (DuraGen) in dural repair:: Analysis of a new modified technique

Study Design. Retrospective review of 110 patients undergoing spinal dural repair and regeneration using an onlay, suture-free, 3-dimensional- collagen matrix graft (DuraGen) over an 8-year period ( 1995 - 2003). Objectives. Technique appraisal of collagen matrix to repair spinal dura following incidental durotomy, spinal tumor surgery, and trauma. Summary of Background Data. Traditional methods of spinal dural repair following incidental durotomy involve tedious attempts at primary watertight suture with a 5% to 10% failure rate. Dural injury occurs after trauma, or dural excision may be required after tumor resection. Collagen matrix is a newer development in collagen sponge. Methods. The clinical and demographic data included diagnosis, type and site of surgery, infection risk, size of defect, use of lumbar drains, closed suction subfascial drains, and adverse events. The primary endpoints of graft failure were cerebrospinal fluid leak and pseudomeningocele formation. Neurosurgical wound infection rates were determined. Results. Collagen matrix was used ( n = 110) in the following conditions: degenerative ( 69), pseudomeningocele formation repair ( 4), tumors ( 14), trauma ( 13), and congenital ( 5). There were 15 cervical ( 10 anterior), 21 thoracic ( 3 anterior), and 71 lumbar ( all posterior) surgeries. Fibrin glue was used in 7.3%, subfascial drains in 82%, and lumbar drainage in 2.7%. Overall, cerebrospinal fluid leaks occurred in 2.7%. The 2 pseudomeningocele formations ( 3.2%) resolved at 3 months. There were 2 wound infections. In the subgroup with incidental durotomy ( n = 69), failure of cerebrospinal fluid containment occurred in 4.3% [ 1 cerebrospinal fluid leak (1.4%), 2 pseudomeningocele formations (2.9%)]. Conclusions. Collagen matrix was successful in cerebrospinal fluid containment in > 95% of patients requiring dural repair following anterior and posterior spinal surgery. Subfascial drains were safe. Routine lumbar drains are not required but are recommended for repair of established pseudomeningocele formations.