title: Durotomy repair in minimally invasive transforaminal lumbar interbody fusion by nonpenetrating clips.
abstract: BACKGROUND
  Closure of the dura defect may be easy to perform in open lumbar surgery but could be difficult in minimally invasive transforaminal lumbar interbody fusions (MIS-TLIF) since MIS-TLIF was done through a small tube, which limited the use of standard dural repair instruments. We used nonpenetrating titanium clips that were originally designed for the vascular anastomoses to repair the dura defect, which is never described in the literature.
  
  
  METHODS
  We presented a case of spinal stenosis with incidental durotomy while performing MIS-TLIF. We closed the dura laceration with three medium-sized nonpenetrating titanium clips (AnastoClip Vessel Closure System, LeMaitre Vascular, Inc., Burlington, MA).
  
  
  RESULTS
  Nonpenetrating titanium clips have the benefits of being technically easy to use, reduced durotomy repair time, decreased bed rest due to related medical complications, superior postoperation with immediate hydrostatic strength, and better reapproximation if it fails to clip successfully. As for the postoperation follow up, clips are tiny and reveal no obvious artifact, especially in cases where the pedicle screws are already causing much artifact.
  
  
  CONCLUSIONS
  Primary dural closure during MIS-TLIF with clips is an effective way in cases that involve limited tubular space.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yen-Po
authors.initials: YP
authors.lastname: Cheng
authors.affiliation: Transplant Medicine and Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ping-Yi
authors.initials: PY
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Abel Po-Hao
authors.initials: AP
authors.lastname: Huang
authors.affiliation: Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chun-Yuan
authors.initials: CY
authors.lastname: Cheng
authors.affiliation: Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chien-Min
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Dueng-Yuan
authors.initials: DY
authors.lastname: Hueng
keywords: Durotomy; minimally invasive lumbar fusion; nonpenetrating titanium clips