Use of Cyanoacrylate (Superglue) for the Repair of Incidental Durotomy During Lumbar Spine Surgery: A Low-Cost Technique in a Resource-Limited Setting

Background Incidental dural tears are a recognized complication of lumbar spine surgery and can lead to significant postoperative morbidity if not properly managed. Standard repair techniques often rely on specialized grafts and sealants that may be costly or unavailable in low-resource settings. This study reports our experience with the use of cyanoacrylate adhesive (superglue) for intraoperative repair of dural tears in a resource-limited environment. Methods We retrospectively reviewed patients who sustained incidental dural tears during lumbar spine surgery at a tertiary spine centre in a resource-limited setting between January 2022 and June 2025. All tears were identified intraoperatively and repaired immediately. In six cases, cyanoacrylate adhesive was used as part of the dural repair strategy. In two patients, lumbar fascia grafts were used to cover inaccessible tears and reinforced with Surgicel™ (Ethicon, Inc., Raritan, New Jersey) before application of cyanoacrylate adhesive. In four patients, autologous fat grafts and Surgicel™ were similarly used prior to cyanoacrylate application. Postoperative outcomes, including cerebrospinal fluid (CSF) leakage, wound infection, pseudomeningocele formation, and need for reoperation, were reviewed. Results Among 68 patients who underwent lumbar spine surgery, nine (13.2%) sustained intraoperative dural tears, and six of these were managed using cyanoacrylate-assisted repair. Watertight closure was achieved intraoperatively in all cases. One patient developed a mild superficial wound infection that resolved with antibiotics, while another developed a pseudomeningocele following revision surgery that was managed conservatively. There were no cases of persistent CSF leakage, meningitis, or reoperation. Conclusion Cyanoacrylate-assisted repair appeared to provide a feasible and low-cost adjunct for dural repair in this limited case series. When used in conjunction with autologous grafts and Surgicel™, satisfactory short-term outcomes were observed without major complications. Further prospective studies are needed to better establish long-term safety and effectiveness.