DURAL TEAR: A FEARED COMPLICATION IN LUMBAR SPINE SURGERY

Sohail Amir Sohail Amir,Bilal Khan Bilal Khan,Khaleeq-Uz-Zaman Khaleeq-Uz-Zaman,Aurangzeb Aurangzeb

doi:10.37723/jumdc.v10i4.77

Sohail Amir Sohail Amir, Bilal Khan Bilal Khan + Show 2 more

Open Access

https://doi.org/10.37723/jumdc.v10i4.77

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Abstract

ABSTRACT:OBJECTIVE: The objective of this study is to determine the incidence of dural tear in lumbar spine surgeries and associated risk factors. MATERIAL AND METHODS: In this descriptive cross sectional study, 117 Patients were studied in the department of Neurosurgery, Naseer Teaching Hospital Peshawar from February 2013 to December 2016. All patients with either gender or age who needed spinal surgery for lumbar disc disease, spinal stenosis, and re-do surgery were included in study while those with trauma, tumor and infection were excluded. Data was collected regarding the age of patients, co-morbid conditions, lumbar spine disease, level of involvement, type of operation, occurrence of dural tear, site of dural tear and complications were recorded on a predesigned proforma. Data was analyzed using SPSS version 20.0. RESULTS: Out of 117 patients 63(53.8%) were male and 54(46.1%) were female. Male to female ratio was 1.2:1. In our study the age of patient ranged from 16 to 80 years with mean age 38 + 2.34 years Dural tear occurred in 15(12.8%) of patients, among these 5 (4.2%) dural tear in lumbar disc prolapsed , 8(6.8%) in spinal stenosis and 2 (1.7%) in surgery for recurrent disc disease. The complication rate was 19(16.2%), among these the most common complication was cerebrospinal ﬂuid leak (CSF) in 7(5.9%), delayed wound healing in 5(4.2%), discitis in 4(3.4%) and others in 3(2.5%) of patients. CONCLUSION: Dural tear (DT) is not uncommon complication during spinal surgery and represent a serious challenge for both surgeon and patients. Female, obese, older age, re-do surgery are the major risk factor for dural tear.

Highlights

Dural tear (DT) is not an uncommon complication during spinal surgery and represent a serious challenge for both surgeon and patients
All patients with either gender or age between 16 to 80 years having lumbar disc disease, lumbar spinal stenosis, and those patients who need re-operation for recurrent disc disease were included in the study, patient presented with spinal trauma, infection, tumour, and listhesis were excluded from the study
Lumbar spine diseases like lumbar disc herniation, spinal stenosis, recurrent disc, level of involvement, type of operation like unilateral interlamar, bilateral interlamar, hemilaminectomyand laminectomy, occurrence of dural tear and complications like cerebrospinal fluid leakage (CSF), pseudomeningocele, dural-cutaneous fistula, arachnoidits, epidural abscess were recorded on a predesigned proforma

Summary

Introduction

Dural tear (DT) is not an uncommon complication during spinal surgery and represent a serious challenge for both surgeon and patients. Despite effective treatment modalities most of surgeons are feared of this complication[1]. The major risk factors were age of patient, surgeon experience, type of surgery, and obesity[5,6]. The introduction of complex spinal surgeries and spinal instrumentation in the last few decades has a strong association with increased incidence of dural tear[2]. DT occurs either as a direct laceration or due to immense pressure of the extruded disc or yellow ligaments on dural sac, it may occur during implantation of spinal instruments[7,8].

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