Suture Choice in Lumbar Dural Closure Contributes to Variation in Leak Pressures: Experimental Model.

Suture Choice in Lumbar Dural Closure Contributes to Variation in Leak Pressures: Experimental Model.

Clin Spine Surg. 2016 Jun 28;

Authors: Ghobrial GM, Maulucci CM, Viereck MJ, Beygi S, Chitale A, Prasad S, Jallo J, Heller J, Sharan AD, Harrop JS

Abstract
STUDY DESIGN: Open-label Laboratory Investigational Study; Non-animal Surgical Simulation OBJECTIVES:: The authors perform a comparison of dural closure strength in a durotomy simulator across two different suture materials.
SUMMARY OF BACKGROUND DATA: Incidental durotomy leading to persistent cerebrospinal fluid (CSF) leak adds considerable morbidity to spinal procedures, often complicating routine elective lumbar spinal procedures. Using an experimental durotomy simulation, the authors compare the strength of closure using Gore-tex™ with other suture types and sizes, using various closure techniques.
METHOD: A comparison of dural closures was performed through an analysis of the peak pressure at which leakage occurred from a standardized durotomy closure in an established CSF repair model with a premade L3 laminectomy. Nurolon™(Ethicon, Somerville, NJ) was compared to Gore-tex™ (Goremedical, Flagstaff, AZ) sutures sizes (for Gore-tex™, CV-6™/5-0 and CV-5™/4-0 was compared to Nurolon™ 4-0, 5-0, and 6-0).
RESULTS: 36 trials were performed with Nurolon™ 4-0, 5-0, and 6-0, while 21 trials were performed for 4-0 and 5-0 Gore-tex™. The mean peak pressure at which fluid leakage was observed was 21 cm H20 for Nurolon™ and 34 cm H20 for Gore-tex™. Irrespective of suture choice, all trials were grouped by closure technique: running suture, locked continuous, and interrupted suture. No significant difference was noted between the groups. For each of the three trials groups by closure technique, running, locked continuous, and interrupted, Gore-tex™ closures had a significantly higher peak pressure to failure. Interrupted Gore-tex™ was significantly higher than Interrupted Nurolon™ (P=0.007), running Gore-tex™ was significantly higher than running Nurolon ™(P=0.034), and locked Gore-tex™ was significantly higher than locked Nurolon™(P=0.014).
CONCLUSIONS: Durotomy closure in the lumbar spine with Gore-tex™ suture may be a reasonable option for providing a watertight closure. In this laboratory study, Gore-tex™ suture provided watertight dural closures that withstood higher peak pressures.

PMID: 27355713 [PubMed - as supplied by publisher]

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