{
  "abstract": "Background: Incidental durotomy is a recognized complication of spinal surgery and can cause persistent cerebrospinal fluid (CSF) leakage, wound complications, and reoperation. We describe the 4D repair technique and report postoperative outcomes from a single-center clinical series. Methods: This retrospective descriptive study included 112 patients treated between 2005 and January 2025. The 4D technique combines double-layer continuous dural suturing, fibrin sealant, an autologous dermal-fat graft, and passive subfascial drainage. Clinical characteristics and postoperative outcomes were summarized descriptively without a historical comparator. Results: Mean age was 64.1 ± 9.2 years; 60 patients (53.6%) were male. Persistent CSF leakage occurred in 3 patients (2.7%), symptomatic pseudomeningocele in none, CSF fistula in 1 (0.9%), and wound dehiscence in 2 (1.8%). Nine patients (8.0%) underwent reoperation for any indication. No postoperative meningitis was recorded. Mean hospital stay was 9.1 ± 3.8 days and mean passive drainage duration was 7.5 ± 2.3 days. Conclusions: This illustrated 112-patient experience describes the application and observed postoperative course of a standardized multimodal dural repair technique. The descriptive design does not establish comparative effectiveness or the independent contribution of individual steps.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Orthopedics and Trauma Surgery, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy",
    "Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome Tor Vergata, 00133 Rome, Italy"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Andrea Franchini"
    },
    {
      "affs": [
        1
      ],
      "name": "Giuseppe Rovere"
    },
    {
      "affs": [
        0
      ],
      "name": "Felice Barletta"
    },
    {
      "affs": [
        0
      ],
      "name": "Franco Lucio Gorgoglione"
    },
    {
      "affs": [
        0
      ],
      "name": "Andrea Perna",
      "orcid": "0000-0002-2475-1955"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/82qby09m0v10b.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218278",
  "fulltext_url": null,
  "id": "82qby09m0v10b",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8278",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2728|Neurosurgical Procedures and Complications"
    ]
  ],
  "openalex": "W7223791056",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-24",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/82qby09m0v10b.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:01Z",
      "native_id": "10.3390/jcm15218278",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8278"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Neurosurgical Procedures and Complications",
      "subfield": "neurology"
    }
  ],
  "title": "The 4D Repair Technique for Incidental Durotomy in Spine Surgery: Surgical Technique and Clinical Outcomes in 112 Patients",
  "title_text": "The 4D Repair Technique for Incidental Durotomy in Spine Surgery: Surgical Technique and Clinical Outcomes in 112 Patients",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:01Z",
  "url": "https://research.draconitic.com/paper/82qby09m0v10b",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}