Plug-shaped Autologous Fat Graft Repair for Dural Tear in Lumbar Spine Surgery

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ObjectiveThe aim of this study was to evaluate the clinical outcomes of patients undergoing lumbar spine surgery who developed intraoperative dural tear and were treated with plug-shaped autologous fat graft repair, and to compare these outcomes with those of patients without dural injury.Materials and MethodsThis retrospective, single-center study included 124 patients who underwent surgery for lumbar disc herniation or lumbar spinal stenosis between 2019 and 2025. All procedures were performed by a single surgeon using a posterior midline approach under general anesthesia. In cases of dural tear, the defect was repaired using a plug-shaped autologous fat graft without primary suturing. Clinical outcomes were assessed using preoperative and postoperative Visual Analog Scale (VAS) scores. Statistical analyses were performed to evaluate associations between dural tear, recurrence, gender, surgical side, and clinical outcomes.ResultsDural tear occurred in 8 patients (6.4%). After exclusion of recurrent cases, the incidence decreased to 4.3%. The risk of dural tear was significantly higher in patients reoperated for recurrent lumbar disc herniation (p = 0.013). No cerebrospinal fluid leakage was observed in patients treated with plug-shaped autologous fat graft repair. Postoperative VAS improvement did not differ significantly between patients with and without dural tear, although numerical improvement was greater in the dural tear group. Gender, surgical side, and surgeon hand dominance were not significantly associated with dural tear occurrence.ConclusionPlug-shaped autologous fat graft repair effectively prevented cerebrospinal fluid leakage in patients with intraoperative dural tear during lumbar spine surgery. Despite dural injury, postoperative pain outcomes were preserved. Revision surgery was associated with an increased risk of dural tear.

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