Durotomy In Lumbar Spine Surgery Research Articles

Frequency of CSF Leak after Primary Repair of Incidental Durotomy in Lumbar Spine Surgery with use of Fibrin Glue

Aim: To find the frequency of CSF leakage after primary repair of incidental durotomy in lumbar spine surgery with use of fibrin glue. Study Design: Descriptive case series. Place and duration of study: Neurosurgery Unit 2, Punjab Institute of Neurosciences, Lahore General Hospital, Lahore from 25-02-2021 to 25-08-2021. Methodology: Sixty five patients admitted for lumbar spine surgery and informed written consent was taken. All the cases were operated in elective operation theatre. Valsalva maneuver was performed per-operatively in all patients to assess CSF leakage. In all patients having incidental durotomy diagnosed per-operatively, primary repair with Prolene 4-0 was done and sealed with fribrin glue. Patients were examined on daily basis for CSF leakage. In case of no complication, patient was discharged on day 07 after surgery. In case of CSF leakage on clinical examination, MRI spine was done. After discharge, patient was followed in OPD on weekly basis for 30 days. CSF leak was done as per operational definition. Results: Total of 65 patients, 41(63.1%) were in age group of 16-40 years and 187(36.9%) were in age group of 41-75 years and mean age was calculated as 38.93±11.47 years. There were 44(67.7%) were male whereas 21(32.2%) were females. Frequency of CSF leakage was 9(13.8%) after primary repair of incidental durotomy in lumbar spine surgery with use of fibrin glue. Practical Implication: We found that frequency of CSF leakage was 13.8% after primary repair of incidental durotomy in lumbar spine surgery with use of fibrin glue. The rate of CSF leakage is low. Therefore, we concluded that fibrin glue is useful for the treatment of incidental durotomy in lumber spine surgery. Conclusion: This study showed that the CSF leakage was 13.8%. As the rate of CSF leakage is low. Therefore, we concluded that fibrin glue is useful for the treatment of incidental durotomy in lumbar spine surgery. Keywords: Cerebrospinal Fluid Leak, Incidental Durotomy, Lumbar Spine Surgery.

Risk Factors for Unintended Durotomy in Lumbar Spine Surgery

Risk Factors for Unintended Durotomy in Lumbar Spine Surgery

Incidental Durotomy in Lumbar Spine Surgery; Risk Factors, Complications, and Perioperative Management.

Incidental durotomy (ID) can occur in up to 14% of all lumbar spine surgeries. The risk of this complication is markedly higher among elderly patients with advanced spinal pathology. In addition, revision cases and other more invasive procedures increase the risk of ID. When unrepaired, IDs can increase the risk of developing meningitis and can lead to the formation of cerebrospinal fluid fistulas and pseudomeningoceles. Intraoperative recognition and repair are essential to ID management, although repair techniques vary considerably. Although primary suture repair is considered the "benchmark," indirect repair alone has shown comparable outcomes. Given the concern for infection after ID, many have indicated for prolonged prophylactic antibiotic regimens. However, there is little clinical evidence that this is necessary after adequate repair. The addition of subfascial drains have been shown to promote wound healing and early ambulation, whereas no consensus on duration of indwelling drains exists and such management is largely case dependent. Early ambulation after surgery has not shown to be associated with increased risk of further ID complications and decreases rehabilitation time, length of stay, and risk of venous thromboembolism. However, there remains a role for conservation mobilization protocols in more severe cases where notable symptoms are observed.

No benefit of early versus late ambulation after incidental durotomy in lumbar spine surgery: a randomized controlled trial.

Incidental durotomy (ID) is a complication occurring in 4-17% of decompressive spinal surgeries. Persisting CSF leakage can occur even after ID repair and requires revision surgery. Prolonged flat bed rest (BR) to reduce the incidence of persisting CSF leakage is frequently applied but highly debated. A randomized controlled trial comparing prolonged BR versus early ambulation after ID repair is lacking. The aim of this study was to investigate the incidence of revision surgery as a result of persistent cerebro-spinal fluid (CSF) leakage and medical complications after immediate or late post-operative ambulation following ID during decompressive spinal surgery. Ninety-four of 1429 consecutive cases undergoing lumbar spine surgery (6.58%) were complicated by an ID. Sixty patients (mean age of 64 ± 13.28years) were randomized to either early post-operative ambulation (EA, n = 30) or flat BR for 48h (BR, n = 30). The incidence of CSF leakage resulting in revision surgery, medical complications and duration of hospitalization were compared between groups. Two patients in the BR group and two patients in the EA group underwent revision surgery as a result of persisting CSF leakage. Four patients in the BR group experienced medical complications associated with prolonged immobilization. The duration of hospitalization was 7.25 ± 3.0days in the BR group versus 6.56 ± 2.64days in the EA group, p = 0.413. The results of this study indicate no benefit of prolonged BR after an adequately repaired ID in lumbar spine surgery. Level 1b (individual randomized controlled trial). These slides can be retrieved under Electronic Supplementary Material.

Long term effects of subfascial drainage for iatrogenic durotomy in lumbar spine surgery

Long term effects of subfascial drainage for iatrogenic durotomy in lumbar spine surgery

Obesity is associated with an increased rate of incidental durotomy in lumbar spine surgery.

Retrospective database analysis. To determine the impact of obesity on the rate of incidental durotomy in lumbar spine surgery. There is a paucity of data on the overall impact of obesity on the rate of incidental durotomy in lumbar spine surgery, specifically with regard to the type of procedure performed. A large administrative database was queried for all patients who underwent lumbar spine surgery for decompression and/or fusion. They were then stratified into separate cohorts on the basis of body mass index and by procedural codes. Documentation of incidental durotomy was noted. Patient demographics and associated comorbidities were assessed. Odds ratios and 95% confidence intervals were calculated and χ test was used to assess for statistical significance. The incidental durotomy ranged from 0.5% to 2.6%, with the highest rates observed in multilevel laminectomies and revision decompressions in the obese and morbidly obese groups. For patients who underwent decompression only procedures, nonobese patients had a significantly lower rate of durotomy than the obese and morbidly obese cohorts. For patients who underwent fusion with or without decompression, there was a significantly increased rate of durotomy in obese patients compared with nonobese patients. The morbidly obese cohort also had significantly higher rates of incidental durotomy than the nonobese cohort in both revision decompression and revision fusion procedures. This analysis of a large administrative database demonstrates that obesity is associated with increased rates of incidental durotomy in lumbar spine surgery. Furthermore, obesity, in association with increasing complexity of the procedure, increases the rate of incidental durotomy in lumbar spine surgery. Surgeons must be aware of these increased risks as the rate of obesity increases in the population. 3.

Incidental durotomy in lumbar spine surgery - incidence, risk factors and management

Abstract Incidental durotomy is a common complication of lumbar spine operations for degenerative disorders. Its incidence varies depending on several risk factors and regarding the intra and postoperative management, there is no consensus. Our objective was to report our experience with incidental durotomy in patients who were operated on for lumbar disc herniation, lumbar spinal stenosis and revision surgeries. Between 2009 and 2012, 1259 patients were operated on for degenerative lumbar disorders. For primary operations, the surgical approach was mino-open, interlamar, uni- or bilateral, as for recurrences, the removal of the compressive element was intended: the epidural scar and the disc fragment. 863 patients (67,7%) were operated on for lumbar disc herniation, 344 patients (27,3%) were operated on for lumbar spinal stenosis and 52 patients (5%) were operated for recurrences. The operations were performed by neurosurgeons with the same professional degree but with different operative volume. Unintentional durotomy occurred in 20 (2,3%) of the patients with herniated disc, in 14 (4,07%) of the patients with lumbar spinal stenosis and in 12 (23%) of the patients who were operated on for recurrences. The most frequent risk factors were: obesity, revised surgery and the physician’s low operative volume. Intraoperative dural fissures were repaired through suture (8 cases), by applying muscle, fat graft or by applying curaspon, tachosil. There existed 4 CSF fistulas which were repaired at reoperation. Incidental dural fissures during operations for degenerative lumbar disorders must be recognized and immediately repaired to prevent complications such as CSF fistula, osteodiscitis and increased medical costs. Preventing, identifying and treating unintentional durotomies can be best achieved by respecting a neat surgical technique and a standardized treatment protocol.

The intra- and postoperative management of accidental durotomy in lumbar spine surgery: results of a German survey.

The intra- and postoperative management of accidental durotomy in operations of the lumbar spine is not standardized. It is the aim of our survey to obtain an overview on the current practice in neurosurgical departments in Germany. The used questionnaire consisted of three questions and could be answered within a few minutes by checking boxes. In September 2012, the questionnaire was sent to 149 German neurosurgical departments. In the following 4 weeks 109 replies (73.2 %) were received. Seventy-one neurosurgical departments (65.1 %) treat dural tears by a combination of methods, 28 (25.7 %) with suture alone, 7 (6.4 %) with fibrin-coated fleeces alone, 2 (1.8 %) with muscle patch alone and 1 (0.9 %) with fibrin glue alone. Sixty-six neurosurgical departments (60.5 %) decide on postoperative bed rest depending on the quality of the dural closure. Forty-three (39.5 %) neurosurgical departments do not rely on the quality of the dural closure for their postoperative management. In total, 72.5 % of the neurosurgical departments prescribe bed rest for 1-3 days, 1.8 % for more than 3 days, whereas 25.7 % allow immediate mobilization. Among German neurosurgeons, no consensus exists concerning the intra- and postoperative management of accidental durotomies in lumbar spine surgery. Despite not being proved to reduce the rate of cerebrospinal fluid fistulas, bed rest is frequently used. As bed rest prolongs the hospital stay with additional costs and has the potential of a higher rate of medical complications, a prospective multicenter trial is warranted.

Remote Cerebellar Hemorrhage Complicating Unintended Durotomy in Lumbar Spine Surgery.

Case reports and retrospective review of accidental durotomies in lumbar surgeries during 5 years. To draw attention to a potentially serious complication of incidental durotomy-remote cerebellar hemorrhage. Accidental durotomy is a frequent complication of spinal surgery. In most cases the outcome of incidental durotomy is favorable. A delayed potentially serious complication of CSF loss during and after lumbar surgery is remote cerebellar hemorrhage (RCH). During 2008-2012, 1169 lumbar spine procedures were performed at our spine center. In 210 surgeries incidental or intentional durotomies occurred. All patients with durotomies were managed with suturing of the dural wound followed by deep wound drainage left for 5 days and tight wound closure. Of the 210 patients with CSF loss three patients were identified to suffer from RCH-an incidence of 0.26%. The three patients ages 56, 67 and 75 years developed RCH between 36-192 hours after surgery. All three were managed with supportive treatment and close clinical supervision. A gradual clinical and radiological improvement was noted in all three patients. Severe headache after spinal surgery and or declining mental status should not be attributed only to low CSF pressure secondary to dural tearing. It can also be the result of remote cerebral or cerebellar hemorrhage. Once the diagnosis of RCH is made, close clinical supervision is mandatory. In most cases non-operative supportive treatment may lead to eventual full clinical recovery.

Incidental Durotomy in Lumbar Spine Surgery: Incidence, Risk Factors And Management

Background Data: Incidental durotomy is a common complication of lumbar spine operations for degenerative disorders. Its incidence changes depending on a few risk factors. Purpose: Our study aims to estimate the incidence of unintentional durotomy during operations for degenerative lumbar spinal disorders, risk factors as well as the intraoperative and postoperative management of this complication. Patient Sample: Over a 3 years period from January 2011 and December 2013, 630 patients were operated on for degenerative lumbar disorders in our department of neurosurgery. They were clinically followed up for about 24 months. Method: The surgical approaches for primary operations included uni-lateralfenestration, bi-lateral fenestration, hemilaminectomy and laminectomy. The surgeries were performed by different neurosurgeons with different professional degree and operative experience. For patients with canal stenosis, the surgical approaches included bi-lateral fenestration and laminectomy. With regards to recurrent cases, we remove the compressive element, whether it is the epidural scar or the disc fragment. Results: During the study period, 432 patients (68.6%) were operated on for lumbar disc herniation, 172 patients (27.3%) were operated on for lumbar spinal stenosis and 26 patients (4.1%) were operated on for recurrent cases. Incidental durotomy occurred in 30 cases, resulting in an overall incidence rate of 4.76%. Unintentional durotomy occurred in 10 (33.33%) of the patients with herniated disc, in 9 (30%) of thepatients with lumbar spinal stenosis and in 11 (36.67%) of the patients who were operated on for recurrences. The most common risk factors were: obesity, recurrence and the physician’s surgical experience. Intraoperative dural fissures were repaired through suture, by applying muscle or fat graft. Two CSF fistulas existed and repaired during reoperation.Conclusion: Incidental dural fissures during operations for degenerative lumbar disorders should be recognized and immediately fixed to avoid complications such as CSF fistula, osteodiscitis and increased medical costs. Preventing, identifying and managing unintentional durotomies can be optimally achieved by applying and respecting efficient surgical techniques and a standardized treatment protocol. (2014EJ067)

161 Pain and Functional Outcomes After Incidental Durotomy in Lumbar Spine Surgery

161 Pain and Functional Outcomes After Incidental Durotomy in Lumbar Spine Surgery

Incidental durotomy in lumbar spine surgery: incidence and management

There is increasing awareness of the need to inform patients of common complications that occur during surgical procedures. During lumbar spine surgery, incidental tear of the dural sac and subsequent cerebrospinal fluid leak is possibly the most frequently occurring complication. There is no consensus in the literature about the rate of dural tears in spine surgery. We have undertaken this study to evaluate the incidence of dural tears among spine surgeons in the United Kingdom for commonly performed spinal procedures. Prospective data was gathered for 1,549 cases across 14 institutions in the United Kingdom. The results give us a baseline rate for the incidence of dural tears. The rate was 3.5% for primary discectomy, 8.5% for spinal stenosis surgery and 13.2% for revision discectomy. There was a wide variation in the actual and estimated rates of dural tears among the spine surgeons. The results confirm that prospective data collection by spine surgeons is the most efficient and accurate way to assess complication rates for spinal surgery.