Feasibility of dural repair in the lumbar spine using soft-embalmed human cadavers according to Dodge – a pilot study

Abstract

Background

Incidental durotomy is a frequent intraoperative complication in lumbar spine surgery and requires advanced technical skills to prevent adverse outcomes. Despite the importance of surgical proficiency, there is a lack of realistic training models that adequately replicate intraoperative conditions, particularly for dural repair under cerebrospinal fluid (CSF) leakage.

Methods

Four soft-embalmed human cadavers prepared using the Dodge method were used to simulate incidental durotomy and subsequent dural repair under controlled CSF flow conditions. A board-certified spine surgeon performed all procedures. Realism and training value were assessed using a structured Likert-scale questionnaire, evaluating both general training experience and specific surgical steps.

Results

The expert rated the training as a realistic and valuable preparation for clinical practice, with high scores for surgical access, tissue characteristics, and handling of the dura mater. Dural incision and suturing under simulated CSF flow were consistently perceived as realistic. The training was considered beneficial for increasing confidence among less experienced surgeons and was strongly recommended in a workshop setting.

Conclusions

Dura repair on Dodge-embalmed cadavers represents a feasible and realistic training model that closely approximates clinical conditions. This approach may enhance surgical skill acquisition and confidence in managing incidental durotomies. However, the findings are limited by evaluation from a single expert and a small sample size. Further studies involving multiple evaluators and larger cohorts are required to validate these results.