The “Hanging Garden” Method of Incidental Durotomy Repair: An Illustrative Case Report and Technique Description

This article evaluates the utility of the "hanging garden" technique of dural repair, while advocating for formally standardizing and naming the technique.Herein, we describe the illustrative case of a 55-year-old patient who underwent the "hanging garden" technique of dural repair during a Pedicle Subtraction Osteotomy (PSO) for a fixed sagittal deformity.The patient underwent primary suture closure utilizing the "hanging garden" technique.There were no persistent peri/postoperative complications including Cerebrospinal Fluid (CSF) leak, neurological deficit, nerve root injury, vascular injury, nor infection.To the best of our knowledge, we are the first to coin the term "hanging garden" with respect to this technique of dural repair.Previous studies discuss direct (i.e.suture closure) and indirect (i.e.sealant/graft) repair modalities, but have not previously named a systematic method of protecting the nerve rootlets with traction sutures applied to the dura nor have they formally standardized the technique.