Abstract Dura-related complications remain a significant challenge in spinal surgery, with incidental durotomy occurring in 1 to 19% of procedures and epidural fibrosis complicating up to 24% of postlaminectomy cases. Synthetic materials including polyethylene glycol hydrogels, collagen matrices, and fibrin glues carry persistent concerns regarding cost, biocompatibility, and inflammatory potential. Autologous subcutaneous fat grafts, described since 1980, offer universal availability, zero material cost, complete biocompatibility, and a malleable consistency adaptable to complex spinal anatomy; yet comprehensive multi-indication outcome data with rigorous statistical analysis have remained limited. This narrative review synthesizes the published literature on autologous fat graft applications in spinal surgery, supplemented by a 20-year retrospective institutional series of 79 consecutive patients across five indications: incidental dural tear repair (n = 8), dural suture line reinforcement (n = 10), dural defect reconstruction (n = 5), epidural scar prevention (n = 43), and Tarlov cyst treatment (n = 13). A PubMed/MEDLINE search was conducted using terms including autologous fat graft, dural repair, dural tear, epidural fibrosis, and Tarlov cyst (1970–2024). Studies reporting clinical outcomes of fat graft application in spinal procedures involving human subjects were included regardless of study design. The published literature consistently supports fat graft safety and efficacy for spinal dural management; however, prospective comparative data remain sparse. Our institutional series demonstrated an overall success rate of 98.73% (95% CI: 93.48–99.84), with zero external CSF leaks, wound infections, meningitis, new neurological deficits, or pseudomeningoceles across 79 consecutive cases. One internal CSF leak following oncological dural reconstruction resolved with 7 days of conservative lumbar drainage, without surgical revision. All 13 patients with symptomatic Tarlov cysts achieved complete or substantial symptom resolution using a novel intradural fat obliteration technique; nine (69.2%) had previously undergone unsuccessful surgery at other institutions. These outcomes compare favorably with published reoperation rates of 1.8 to 13% for synthetic sealants and collagen matrices, with the additional advantages of zero material cost and elimination of biocompatibility risk. Fat graft effectiveness derives from three complementary mechanisms: immediate mechanical barrier function against CSF extravasation; progressive biological integration with formation of a neodural membrane; and long-term volume retention documented on MRI. Based on the evidence synthesized, autologous fat grafts merit consideration as a first-line technique for dural tear repair, suture line reinforcement, and epidural scar prevention in primary and revision spinal surgery. The intradural obliteration approach for Tarlov cysts substantially exceeds outcomes reported for all currently described alternatives. Prospective multicenter trials are warranted to standardize indications, refine technique protocols, and establish definitive comparative outcomes.
Solmaz et al. (Mon,) studied this question.