Incidental Durotomy in Spine Surgery: First Aid in Ten Steps

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2015 Mar 5

PMID 25735610

Citations 29

Authors

Luca Papavero

Nils Engler

Ralph Kothe

Affiliations

Soon will be listed here.

Abstract

Introduction: Incidental durotomy (ID) is the most common complication of spine surgery. Revision procedures, ossification of the yellow ligament, or synovial cysts are well-known risk factors. The size, shape, and severity of ID are unpredictable, ranging from a pinpoint hole to a several centimeters large dural laceration with transected fibers following the slippage of a cutting burr. Furthermore, the occurrence of ID is always unexpected. Intra-operative management is often based on a steep learning curve rather than a structured scheme.

Purpose: To provide an intra-operative ten-step closure technique (10ST) for IDs of varying severity.

Methods: A database of 4020 consecutive surgeries for lumbar degenerative disease over the past 4 years was searched for ID. The records of 176 patients were analyzed. Two dural repair techniques were compared: the "individual" technique (InT) and the 10ST.

Results: The overall prevalence of ID was 4.4%. The prevalence was lowest in virgin micro-discectomies (1.7%) and ranged from 3.6% in decompression for spinal canal stenosis up to 14.5% in revision procedures. All surgeries were performed with the aid of a microscope. Among 107 primary surgeries, the InT achieved a single-stage closure of the ID in 96 procedures (89.7%). Among 20 virgin surgeries, the 10ST was successful in all cases (P = 0.21). Among 42 re-do procedures following failed attempts to stop cerebrospinal fluid (CSF) leakage, the InT achieved single-stage closure in 36 procedures (85.7%). The 10ST was successful in all 26 cases (P = 0.03). The follow-up was 1 year.

Conclusions: The 10ST should be considered for successful single-stage closure in primary repair of ID.

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References

Ruban D, OToole J . Management of incidental durotomy in minimally invasive spine surgery. Neurosurg Focus. 2011; 31(4):E15. DOI: 10.3171/2011.7.FOCUS11122. View

Felisati G, Bianchi A, Lozza P, Portaleone S . Italian multicentre study on intrathecal fluorescein for craniosinusal fistulae. Acta Otorhinolaryngol Ital. 2008; 28(4):159-63. PMC: 2644991. View

Baker G, Cizik A, Bransford R, Bellabarba C, Konodi M, Chapman J . Risk factors for unintended durotomy during spine surgery: a multivariate analysis. Spine J. 2012; 12(2):121-6. PMC: 3299921. DOI: 10.1016/j.spinee.2012.01.012. View

Keerl R, Weber R, Draf W, Wienke A, Schaefer S . Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: an analysis of 420 administrations and reported complications in Europe and the United States. Laryngoscope. 2004; 114(2):266-72. DOI: 10.1097/00005537-200402000-00016. View

Wiese M, Kramer J, Bernsmann K, Willburger R . The related outcome and complication rate in primary lumbar microscopic disc surgery depending on the surgeon's experience: comparative studies. Spine J. 2004; 4(5):550-6. DOI: 10.1016/j.spinee.2004.02.007. View

Wang J, Bohlman H, Riew K . Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am. 1999; 80(12):1728-32. DOI: 10.2106/00004623-199812000-00002. View

Takahashi Y, Sato T, Hyodo H, Kawamata T, Takahashi E, Miyatake N . Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations: clinical article. J Neurosurg Spine. 2012; 18(2):165-9. DOI: 10.3171/2012.10.SPINE12271. View

Jankowitz B, Atteberry D, Gerszten P, Karausky P, Cheng B, Faught R . Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J. 2009; 18(8):1169-74. PMC: 2899517. DOI: 10.1007/s00586-009-0928-6. View

Guerin P, El Fegoun A, Obeid I, Gille O, Lelong L, Luc S . Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury. 2011; 43(4):397-401. DOI: 10.1016/j.injury.2010.12.014. View

10.

Cammisa Jr F, Girardi F, Sangani P, Parvataneni H, Cadag S, Sandhu H . Incidental durotomy in spine surgery. Spine (Phila Pa 1976). 2000; 25(20):2663-7. DOI: 10.1097/00007632-200010150-00019. View

11.

Mulder M, Crosier J, Dunn R . Cauda equina compression by hydrogel dural sealant after a laminotomy and discectomy: case report. Spine (Phila Pa 1976). 2009; 34(4):E144-8. DOI: 10.1097/BRS.0b013e31818d5427. View

12.

Eismont F, Wiesel S, Rothman R . Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am. 1981; 63(7):1132-6. View

13.

Kalevski S, Peev N, Haritonov D . Incidental Dural Tears in lumbar decompressive surgery: Incidence, causes, treatment, results. Asian J Neurosurg. 2011; 5(1):54-9. PMC: 3198662. View

14.

Epstein N . The frequency and etiology of intraoperative dural tears in 110 predominantly geriatric patients undergoing multilevel laminectomy with noninstrumented fusions. J Spinal Disord Tech. 2007; 20(5):380-6. DOI: 10.1097/BSD.0b013e31802dabd2. View

15.

Khan M, Rihn J, Steele G, Davis R, Donaldson 3rd W, Kang J . Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976). 2006; 31(22):2609-13. DOI: 10.1097/01.brs.0000241066.55849.41. View

16.

Epstein N . Dural repair with four spinal sealants: focused review of the manufacturers' inserts and the current literature. Spine J. 2010; 10(12):1065-8. DOI: 10.1016/j.spinee.2010.09.017. View

17.

Desai A, Ball P, Bekelis K, Lurie J, Mirza S, Tosteson T . Surgery for lumbar degenerative spondylolisthesis in Spine Patient Outcomes Research Trial: does incidental durotomy affect outcome?. Spine (Phila Pa 1976). 2011; 37(5):406-13. PMC: 3279597. DOI: 10.1097/BRS.0b013e3182349bc5. View

18.

Desai A, Ball P, Bekelis K, Lurie J, Mirza S, Tosteson T . SPORT: does incidental durotomy affect long-term outcomes in cases of spinal stenosis?. Neurosurgery. 2011; 69(1):38-44. PMC: 4517460. DOI: 10.1227/NEU.0b013e3182134171. View

19.

Park P, Leveque J, La Marca F, Sullivan S . Dural closure using the U-clip in minimally invasive spinal tumor resection. J Spinal Disord Tech. 2010; 23(7):486-9. DOI: 10.1097/BSD.0b013e3181c7e901. View

20.

McMahon P, Dididze M, Levi A . Incidental durotomy after spinal surgery: a prospective study in an academic institution. J Neurosurg Spine. 2012; 17(1):30-6. DOI: 10.3171/2012.3.SPINE11939. View