Dural Closure Using the U-clip in Minimally Invasive Spinal Tumor Resection

Study Design Technical case report. Objective To report an alternative to suture for dual closure in minimally invasive spinal surgery. Summary of Background Data Dural closure in minimally invasive spinal intradural tumor resection can be technically challenging. The U-clip is a novel self-closing device that was originally designed to facilitate coronary arterial anastomosis by obviating the need for suture management and knot tying. Given its ability to achieve tissue approximation without knot tying, the U-clip is ideal for dural closure in the narrow surgical corridors provided by the retractors used in minimally invasive procedures. Methods We report the results of 2 cases in which the U-clip device was used for dural closure after minimally invasive spinal resection of an intradural mass. Results Two patients presented with spinal intradural tumors. Patient 1 presented with severe upper back pain and was found to have an intradural extramedullary mass at T2 causing severe spinal cord compression. Patient 2 was incidentally found to have an intradural mass causing significant compression of the cauda equina at L2-3. Both patients underwent minimally invasive tumor resection using an expandable tubular retraction system. Dural closure was accomplished using the U-clip device in conjunction with Tisseal. Postoperatively, both patients were mobilized early and neither developed symptoms related to cerebrospinal fluid leakage. Conclusions Successful dural closure can be achieved using the U-clip device, thereby eliminating the difficulty associated with suture management and knot tying during minimally invasive spinal procedures.