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  • Incidental durotomy during lumbar spine surgery

    Final Number:
    1192

    Authors:
    Sima Sayyahmelli MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Dural tear causing a cerebrospinal fluid (CSF) leak is a well-known risk of lumbar spinal procedures. The incidence of a CSF leak is higher in cases involving repeated operations and when the surgeon is less experienced; however, the overall outcome of the patient would not be adversely affected by the presence of a dural tear.

    Methods: A prospective evaluation was performed for all patients undergoing elective lumbar spine surgery between July 2007 and March 2009. Inclusion criteria to enter the study were a diagnosis of symptomatic, posterior lumbar disc herniation (LDH) made by spine specialists (orthopaedic and neurosurgeons) in patients aged 18–65 years with pain and/or neurological signs in concordant distribution lasting at least over 6 weeks of appropriate conservative treatment consisting of systemic drugs for pain relief and/or epidural steroid administration. The purpose of the present study was to elucidate incidence, risk factors, and effect on outcome of an incidental dural lesion in lumbar disc herniation surgery.

    Results: In 1116 spinal procedures, 92 dural tears noted intraoperatively were repaired during the procedure by using the fat graft techniques described previously. There were 6 cases of postoperative CSF leak that was readily controlled by placement of additional skin sutures. 1116 patients were prospectively entered in the study, of whom 567 were male (47.2%) and 549 were female (49.3%), with a mean age of 43.2 years (range 22–65 years). In 4 cases pseudomeningocele occurred as a complication of extradural surgery.

    Conclusions: This prospective study has showed an incidence rate of 8.24% concerning dural lesion in lumbar disc herniation surgery. In patients with previous operations, the risk is doubled. Patients with previous surgery have more back pain prior to surgery and a lower quality of life. A conclusion that can be drawn from this study is that a dural lesion is a technical problem which should be solved during surgery and, if so, it bears no negative implications on the 1 year postoperative outcome.

    Patient Care: A conclusion that can be drawn from this study is that a dural lesion is a technical problem which should be solved during surgery and, if so, it bears no negative implications on the 1 year postoperative outcome. The advanced age of the patient, level of the surgeon’s training and the history of surgery was factors affecting this incidence. Pseudomeningoceles and CSF fistulas are rare complications that are usually caused iatrogenically following lumbar surgery. Although these entities are frequently asymptomatic, they can be associated with a range of signs and symptoms including headaches, infection, back pain, radiculopathy, and myelopathy. Magnetic resonance imaging is the neurodiagnostic modality of choice.

    Learning Objectives: In patients with previous operations, the risk is doubled. Patients with previous surgery have more back pain prior to surgery and a lower quality of life.

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