The 4D Repair Technique for Incidental Durotomy in Spine Surgery: Surgical Technique and Clinical Outcomes in 112 Patients
- 1Department of Orthopedics and Trauma Surgery, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy
- 2Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome Tor Vergata, 00133 Rome, Italy
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.
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BibTeX
@article{franchini2026repair,
title = {{The 4D Repair Technique for Incidental Durotomy in Spine Surgery: Surgical Technique and Clinical Outcomes in 112 Patients}},
author = {Andrea Franchini and Giuseppe Rovere and Felice Barletta and Franco Lucio Gorgoglione and Andrea Perna},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218278},
url = {https://www.mdpi.com/2077-0383/15/21/8278},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The 4D Repair Technique for Incidental Durotomy in Spine Surgery: Surgical Technique and Clinical Outcomes in 112 Patients
AU - Andrea Franchini
AU - Giuseppe Rovere
AU - Felice Barletta
AU - Franco Lucio Gorgoglione
AU - Andrea Perna
PY - 2026
DA - 2026/10/24
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218278
UR - https://www.mdpi.com/2077-0383/15/21/8278
AB - 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.
SN - 2077-0383
ER -