{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T19:06:08Z","timestamp":1768676768734,"version":"3.49.0"},"reference-count":7,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>The package insert for DuraSeal (Integra LifeSciences, Princeton NJ) states it is <jats:bold>Contraindicated<\/jats:bold> for use in the anterior cervical spine (confined space): \u201cDo not apply DuraSeal\u00ae hydrogel to confined bony structures where nerves are present since neural compression may result due to hydrogel swelling (\u2026up to 12% of its size in any direction).\u201d Further, it should not be used to treat massive unrepaired cerebrospinal fluid (CSF) leaks in any location; \u201c\u2026(it) is indicated as an adjunct to sutured dural repair during spine surgery to provide watertight closure,\u201d but it is not to be used \u201c...for a gap greater than 2 mm\u2026.\u201d<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>A spinal surgeon interpreted a geriatric patient\u2019s MR as showing severe C3-C4 to C5-C6 anterior cord compression due to disc disease\/spondylosis. However, he never reviewed the CT report\/images that documented marked ossification of the posterior longitudinal ligament (OPLL) with multiple signs of dural penetrance.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>The anterior C4, C5 corpectomy, and C3-C6 strut fusion\/plating resulted in a massive, irreparable cerebrospinal fluid (CSF) leak. Despite the contraindications, the surgeon mistakenly applied DuraSeal which caused the patient\u2019s postoperative quadriplegia (i.e., as documented on the delayed postoperative MR scan). Following a secondary surgery consisting of a laminectomy\/posterior fusion, the patient was still quadriplegic. Further, as he requested no postoperative MR scan and performed no subsequent corrective surgery (i.e., anterior removal of DuraSeal), the patient remained permanently quadriplegic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>DuraSeal is directly contraindicated for use in the anterior cervical spine, with\/without a CSF leak. Here, utilizing DuraSeal for anterior cervical OPLL surgery resulted in permanent quadriplegia, and was below the standard of care.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_875_2021","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T08:48:28Z","timestamp":1634719708000},"page":"532","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Medicolegal corner (spine): Contraindicated use of DuraSeal in anterior cervical spine led to quadriplegia"],"prefix":"10.25259","volume":"12","author":[{"given":"Nancy E","family":"Epstein","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, State University of New York at Stony Brook, NY and c\/o Dr. Marc Agulnick, 1122 Frankllin Avenue Suite 106, Garden City, New York, United States."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Lancione","family":"Esq","sequence":"additional","affiliation":[{"name":"The Lancione Law Firm, Rocky River, Ohio, United States."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2021,10,19]]},"reference":[{"key":"10.25259\/SNI_875_2021\/ref-1","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/S0090-3019(99)00135-4","article-title":"Anterior cervical micro-dural repair of cerebrospinal fluid fistula after surgery for ossification of the posterior longitudinal ligament. Technical note","volume":"52","author":"Epstein","year":"1999","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_875_2021\/ref-2","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1097\/00007632-200101150-00013","article-title":"Identification of ossification of the posterior longitudinal ligament extending through the dura on preoperative computed tomographic examinations of the cervical spine","volume":"26","author":"Epstein","year":"2001","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/SNI_875_2021\/ref-3","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.surneu.2009.05.002","article-title":"Wound-peritoneal shunts: Part of the complex management of anterior dural lacerations in patients with ossification of the posterior longitudinal ligament","volume":"72","author":"Epstein","year":"2009","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_875_2021\/ref-4","doi-asserted-by":"crossref","first-page":"S301","DOI":"10.4103\/2152-7806.111427","article-title":"A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery","volume":"4","author":"Epstein","year":"2013","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_875_2021\/ref-5","doi-asserted-by":"crossref","first-page":"S88","DOI":"10.4103\/2152-7806.130693","article-title":"Cervical surgery for ossification of the posterior longitudinal ligament: One spine surgeon\u2019s perspective","volume":"5","author":"Epstein","year":"2014","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_875_2021\/ref-6","doi-asserted-by":"crossref","first-page":"S93","DOI":"10.4103\/2152-7806.130696","article-title":"What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review","volume":"5","author":"Epstein","year":"2014","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_875_2021\/ref-7","doi-asserted-by":"crossref","first-page":"320","DOI":"10.25259\/SNI_555_2020","article-title":"Reperfusion injury (RPI)\/white cord syndrome (WCS) due to cervical spine surgery: A diagnosis of exclusion","volume":"11","author":"Epstein","year":"2020","journal-title":"Surg Neurol Int"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/medicolegal-corner-spine-contraindicated-use-of-duraseal-in-anterior-cervical-spine-led-to-quadriplegia\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/medicolegal-corner-spine-contraindicated-use-of-duraseal-in-anterior-cervical-spine-led-to-quadriplegia\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T08:49:04Z","timestamp":1634719744000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/medicolegal-corner-spine-contraindicated-use-of-duraseal-in-anterior-cervical-spine-led-to-quadriplegia\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,19]]},"references-count":7,"alternative-id":["10.25259\/SNI_875_2021"],"URL":"https:\/\/doi.org\/10.25259\/sni_875_2021","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,19]]},"article-number":"532"}}