P15. Can cervical and lumbar epidural blood patches help avoid revision surgery for symptomatic postoperative dural tears?

Abstract

<h3>BACKGROUND CONTEXT</h3> Incidental durotomies resulting in symptomatic postoperative cerebrospinal fluid (CSF) leaks are a known sequela of spine surgeries. Treatments include bedrest, subarachnoid lumbar drain, epidural blood patch, and most commonly, surgical reexploration for durotomy closure. Surgical reexploration carries the inherent consequences of an additional surgical procedure. The theory behind epidural blood patches is to form a clot over the tear in a minimally invasive manner and to allow the dura to heal without the need for additional surgery. Within the literature, there is a paucity of data available evaluating the efficacy of epidural blood patches for CSF leaks secondary to incidental durotomies. <h3>PURPOSE</h3> The purpose of this study is to describe our center's outcomes and complications following epidural blood patches for symptomatic postoperative durotomies. <h3>STUDY DESIGN/SETTING</h3> Retrospective case series. <h3>PATIENT SAMPLE</h3> All patients undergoing cervical, thoracolumbar, or posterior lumbar spine surgeries at an academic institution between 10/2012 and 12/2020 were included. <h3>OUTCOME MEASURES</h3> Rate of dural tears, type of dural repair, use of blood patches for dural tears, intraoperative/perioperative complications, length of hospital stay, discharge status. <h3>METHODS</h3> Patients undergoing cervical, thoracolumbar, and posterior lumbar surgeries performed by a single surgeon at an academic institution between 10/2012 and 12/2020 were included. Their charts were reviewed retrospectively for demographic information, type of surgery, rate of dural tear, type of repair, and use of blood patches postoperatively. <h3>RESULTS</h3> A total of 1,392 patients (726 males, 666 females, average age: 56.3 ±15.4 years old) were included who received cervical, thoracolumbar, or posterior lumbar surgeries. Of the 436 cervical spine surgeries, there were 236 anterior cervical fusions, 183 posterior cervical surgeries, and 17 anterior and posterior cervical surgeries. Of the 956 thoracolumbar and posterior lumbar spine surgeries, there were 207 laminectomies, 458 fusions and 291 microdiscectomies. There were 6 (1.4%) cervical, 65 (6.8%) lumbar, a total of 71 (5.1%) patients identified with incidental dural tears/blebs. Durotomies were fixed primarily, or if they were inaccessible, then treated with duraseal and/or fat graft. Persistent CSF leaks were indicated by positive beta-2 transferrin or clinical symptoms of positional headaches; these patients were referred to interventional radiology for a blood patch. We identified 2 (2 males) cervical spine and 8 (4 females and 4 males) lumbar spine patients who received blood patches in this study. Nine of 10 patients had resolution of symptoms without reaccumulation of fluid (90%). One lumbar spine surgery patient had a persistent pseudomeningocele after a blood patch and subsequently underwent primary repair with no relief. A second blood patch was then performed, which alleviated his symptomatic pseudomeningocele. Of the10 total patients who received blood patches, the mean length of hospital stay was 10.4 days, and three were discharged to rehabilitation. <h3>CONCLUSIONS</h3> The rate of dural tears/blebs within this series was 1.4% in cervical spine, 6.8% in lumbar spine, and 5.1% in total spine surgeries. Of the 10 patients with symptomatic postoperative CSF leaks, 9 out of 10 were successfully treated with a blood patch. Targeted epidural blood patch is an effective option to treat symptomatic CSF leaks that minimizes the morbidity of surgical reexploration. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.