Efficacy and safety for the novel use of the EVARREST fibrin patch in management of incidental durotomies

Introduction: While infrequent, incidental durotomies have an overall incidence ranging from 1.7-14% and can lead to associated complications in elective spine surgery. As compared to intended durotomies, incidental durotomies come with more technical considerations in terms of management. Although primary suture closure is the most common type of repair, there is currently no standardized management approach for difficult repairs. Fibrin vascular repair patches (i.e. Tachosil) have shown efficacy in the treatment of intended durotomies with additional primary closure. However, in incidental durotomies, primary closure is not always technically possible and can lead to continued CSF leaks. This case series aims to report the safety and efficacy of the EVARREST fibrin sealant patch to manage incidental durotomies in spine patients. This is the first reported use of EVARREST for durotomy management.

Methods: A retrospective case series study was conducted at a large academic hospital from 2021-2022 for which incidental durotomies were managed with the use of the EVARREST patch. Basic demographic data as well as risk factors for CSF leak were reported. Clinical outcomes measures included post operative postural headache, continued CSF leak, and wound complications.

Results: A total of 12 patients had EVARREST patch repair of incidental durotomy with an average follow-up time of 4.8 months. No continued CSF leak was reported, and zero patients required a return to the operating room. Patch repair was completed for the following types of cases: one anterior cervical, one posterior thoracic, and ten posterior lumbar. Eight cases were open and four were minimally invasive. Only three patients had primary closure in addition to patch closure. Two patients had superficial wound dehiscence that healed with local wound care. One patient had postural headache immediately postoperatively that resolved spontaneously.

Conclusion : Here we reported on the novel use of EVARREST, a fibrin sealant patch, for the management of complicated CSF repairs in 12 patients. Our case series supports the EVARREST patch as a safe, efficacious method in the management of incidental durotomies in a wide variety of spine cases with or without primary closure.