Titanium Clips for Dural Closure in Intradural Spine Procedures: A Systematic Review and Meta-Analysis

Study Design: Systematic review and meta-analysis. Objective: This meta-analysis evaluates the safety and efficacy of these clips for dural closure in spinal procedures. Summary of Background Data: Watertight dural closure is critical in intradural spinal surgery to prevent cerebrospinal fluid (CSF) leaks and associated complications. While suturing remains the standard, it can be technically challenging in confined spaces. Nonpenetrating titanium clips have been introduced as an alternative, potentially offering a faster and more facile closure. Materials and Methods: This study was conducted according to the PRISMA guidelines. A systematic search of PubMed, Embase, and Web of Science databases was performed. Data on postoperative complications were analyzed using a random-effects model to calculate pooled proportions. Subgroup analyses were made based on age. Results: Seven studies were included, comprising a total of 843 patients, of whom 400 were men (47.9%). The population included both pediatric and adult patients, with a cumulative mean age of ∼25.1 years. The pooled proportion for postoperative CSF leak was 3% (95% CI: 1%–6%; I 2 =39.8%). The rate of surgical site infection was 1% (95% CI: 0%–5%; I 2 =64.6%), and the rate of pseudomeningocele formation was 1% (95% CI: 0%–4%; I 2 =58.7%). No procedure-related mortality was reported across all studies. Heterogeneity was moderate across all outcomes, partly attributable to one outlier study with higher complication rates. Conclusion: This meta-analysis suggests that nonpenetrating titanium clips offer low rates of key postoperative complications. Further prospective studies are warranted to directly compare their efficacy and cost-effectiveness against standard suture techniques.