Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Aug 28;5(Suppl 7):S304-14.
doi: 10.4103/2152-7806.139615. eCollection 2014.

Hemostasis and other benefits of fibrin sealants/glues in spine surgery beyond cerebrospinal fluid leak repairs

Nancy E Epstein  1
Affiliations

Hemostasis and other benefits of fibrin sealants/glues in spine surgery beyond cerebrospinal fluid leak repairs

Nancy E Epstein. Surg Neurol Int. .

Abstract

Background: Fibrin sealants (FS)/glues (FG) are primarily utilized in spinal surgery to either strengthen repairs of elective (e.g., intradural tumors/pathology) or traumatic cerebrospinal fluid (CSF) fistulas. Here, additional roles/benefits of FS/FG in spine surgery are explored; these include increased hemostasis, reduction of scar, reduction of the risk of infection if impregnated with antibiotics, and its application to restrict diffusion and limit some of the major complications attributed to the controversial "off-label" use of bone morphogeneitc protein (rhBMP-2/INFUSE).

Methods: We reviewed multiple studies, focusing not just on the utility of FS/FG in the treatment of CSF fistulas, but on its other applications.

Results: FS/FG have been primarily used to supplement elective/traumatic dural closure in spinal surgery. However, FS/FG also contribute to; hemostasis, reducing intraoperative/postoperative bleeding/transfusion requirements, length of stay (LOS)/costs, reduced postoperative scar/radiculitis, and infection when impregnated with antibiotics. Nevertheless, one should seriously question whether FS/FG should be applied to prevent diffusion and limit major complications attributed to the "off-label" use of BMP/INFUSE (e.g., limit/prevent heterotopic ossification, dysphagia/respiratory decompensation, and new neurological deficits).

Conclusions: FS/FG successfully supplement watertight dural closure following elective (e.g., intradural tumor) or traumatic CSF fistulas occurring during spinal surgery. Additional benefits include: intraoperative hemostasis with reduced postoperative drainage, reduced transfusion requirements, reduced LOS, cost, scar, and prophylaxis against infection (e.g., impregnated with antibiotics). However, one should seriously question whether FS/FG should be used to contain the diffusion of BMP/INFUSE and limit its complications when utilized "off-label".

Keywords: Benefits; Tisseel; complications; fibrin sealant; hemostasis; length of stay; lumbar surgery; reduced spread BMP/INFUSE.

PubMed Disclaimer

References

    1. Bou Monsef J, Buckup J, Waldstein W, Cornell C, Boettner F. Fibrin sealants or cell saver eliminate the need for autologous blood donation in anemic patients undergoing primary total knee arthroplasty. Arch Orthop Trauma Surg. 2014;134:53–8. - PubMed
    1. Cammisa FP, Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental durotomy in spine surgery. Spine (Phila Pa 1976) 2000;25:2663–7. - PubMed
    1. Cashman JD, Jackson JK, Mugabe C, Gilchrist S, Ball K, Tredwell S, et al. The use of tissue sealants to deliver antibiotics to an orthopaedic surgical site with a titanium implant. J Orthop Sci. 2013;18:165–74. - PubMed
    1. Cekinmez M, Sen O, Atalay B, Erdogan B, Bavbek M, Caner H, et al. Effects of glue and combination of methyl prednisolone acetate and fibrin glue in prevention of epidural fibrosis in a rat model. Neurol Res. 2010;32:700–5. - PubMed
    1. Dafford EE, Anderson PA. Comparison of dural repair techniques. Spine J. 2013;(13):S1529–9430. 00719-5. - PubMed