Journal List > J Korean Soc Spine Surg > v.9(3) > 1036016

Kim, Choi, Kim, Chung, Park, and Park: Dural Tears Secondary to Operations of the Lumbar Spinal Disorders

Abstract

Study Design

A retrospective study.

Purpose

To review the results of the treatment of dural tears, sustained during operations on the lumbar spinal disorders.

Materials and Methods

From Jan. 1991 to Dec. 2000, 694 consecutive patients had a decompression of the lumbar spine, 35(5%) patients sustained a dural tear during the operations. Of 32 patients who were followed up for more than one year, 29 patients were detected dural tear intraoperatively. 24 patients were treated with primary repair, 4 patients with fibrin glue and one patient with dural reconstruction and fibrin glue. Postoperative management consisted of closed wound drainage for an average of 3.3 days and bed rest for an average of 9.3 days.

Results

The total subfascial drains averaged an output of 626(18- 1698) milliliters of 32 patients. Clinical symptoms were complained of headache in 12 patients, nausea in 7 patients, dizziness and vomiting in 2 patients postoperatively, but all had resolution of these symptoms after conservative treatment. A superficial wound infection occurred in one of these patients, managed with antibiotic therapy. Whereas the deep wound infection occurred in one, managed with wound debridement and antibiotic therapy successfully. A mean follow up of 34 months was available and showed satisfactory clinical results for 29 of the patients(91%).

Conclusion

Closed wound drainage can be used safely in the presence of a dural repair and the patient needs to keep on bed rest while the drainage into a sterile bag is performed.

REFERENCES

1). Bosacco SJ, Gardner MJ, Guille JT. E valu ati on and treatment of dural tears in lumbar spine surgery. Clin Orthop. 389:238–247. 2001.
2). Cain JE, Dryer RF, Barton BR. Evaluation of dural closure techniques: Suture methods, fibrin adhesive sealant, and cyanoacrylate polymer. Spine. 13:720–728. 1988.
3). Cammisa FP, Eismont FJ, Green BA. Dural laceration occurring with burst fracture and associated laminar fractures. J Bone Joint Surg. 71A:1044–1052. 1989.
4). Cammisa FP, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental durotomy in spine surgery. Spine. 25:2663–2667. 2000.
crossref
5). Eismont FJ, Wiesel FW, Rothman RH. Treatment of dural tears associated with spinal surgery. J Bone Joint Surg. 63A:1132–1136. 1981.
crossref
6). Finnegan WJ Fenlin JM, Marvel JP, Nardini RJ, Rothman RH. Results of surgical intervention in the sympathetic multiply-operated back patient. Analysis of sixty- seven cases followed for three to seven years. J Bone Joint Surg. 61A:1077–11082. 1979.
7). Foty D, Johnson JP, Kirsch AJ, Bruce JN, Waren JJ. Dural closure with laser tissue welding. Otolaryngol.-head and Neck Surg. 115:513–518. 1996.
8). Hodges SD, Humphreys SC, Eck JC, Covington LA. Management of incidental durotomy without mandatory bed rest. Spine. 24:2062–2064. 1999.
crossref
9). Jones AAM, Stambongh JL, Balderston RA. Long term results of lumbar spinal surgery complicated by unintended incidental durotomy. Spine. 14:443–446. 1989.
10). Kitchel SH, Eismont FJ, Green BA. Closed sub -arachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg. 71A:984–987. 1989.
11). Kim NH, Kim DJ. Anterior interbody fusion for spondylolisthesis. Orthopedics. 14:1069. 1991.
crossref
12). Lauerman WC, Wiesel SW. Management of the patient with failed low back surgery. (in. Chapman MW, editor. Chapman's orthopaedic surgery. 3rd ed. phildelphia: Lppincott Williams & Wilkins;p. 3861. 2001. .).
13). Lenke LG, Pridwell KH, Bull D, Betz RR, Baldus C, Schoenecker PL. Result of in situ fusion isthmic spondylolisthesis. J Spinal Disorders. 5:433–442. 1992.
14). Mayfield FH, Kurokawa K. Watertight closure of spinal duramater; Technical note. J Neurosurg. 43:639–640. 1975.
15). Miller PR, Elder FW. Meningeal pseudocyst (me-ningocele spurius) following laminectomy. Report of ten cases. J Bone Joint Surg. 50A:268–276. 1968.
16). Nash CL, Kaufman B, Frankel VH. Postsurgical meningeal pseudocyst of the lumbar spine. Clin Orthop. 75:167–178. 1971.
17). Patel MR, Louie W, Rachlin J. Postoperative cerebrospinal fluid leaks of the lumbosacral spine: management with percutaneous fibrin glue. Am J Neuroradiol. 17:495–500. 1996.
18). Wang JC, Borlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. J Bone Joint Surg. 80A:1728–1732. 1998.

Figures and Tables%

Fig. 1.
Longitudinal sonogram of 52 years old woman(No. 20). An abnormal fluid-filled cyst is seen as a hypoechoic lesion under the paraspinal muscle.
jkss-9-191f1.tif
Table 1.
Morbidity of dural tears according to diagnosis
HNP Stenosis Revision Total
No. of patients 209 416 69 694
No. of tears 3(1%) 24(6%) 8(12%) 3 35(5%)

No∗, number; HNP

, herniated nucleosus pulposus

Table 2.
Summary of patients
No. Age Sex Dx. Detect Op Dura Tx drain day T. amount(ml)§ Sxs|| CI. result Rad.∗∗ Cxs†† F/U(M)††
1 67 M Stenosis intraop decom & fu§§ repair & Fi|| || 2 239 G В 12
2 57 M Stenosis intraop de com & fu repair & Fi 2 417 G В 23
3 60 F spondylolisthesis intraop decom & fu repair & Fi 3 140 nausea G С 16
4 66 M spondylolisthesis intraop decom & fu repair & Fi 5 1609 G В 12
5 50 F Stenosis postop decom & fu 6 817 headache G А 25
6 49 F spondylolisthesis intraop decom & fu repair 3 706 headache E А 96
7 50 F Stenosis intraop decom & fu repair 2 301 headache & dizziness G В 58
8 56 F Stenosis intraop decom & fu repair & Fi 2 681 G В 98
9 68 M revision intraop decom & fu repair & Fi 6 955 headache G D infection 19
10 50 M spondylolisthesis intraop decom & fu Fi 1 283 nausea G В 38
11 64 F spondylolisthesis intraop decom & fu repair & Fi 2 498 headache G В 12
12 18 F HNP” intraop decom repair & Fi 6 480 headache G 12
13 62 F spondylolisthesis intraop decom & fu repair & Fi 3 509 nausea F А 20
14 57 F revision intraop decom & fu repair & Fi 2 610 nausea & vomiting E А 70
15 71 M revision intraop decom & fu repair & Fi 3 1276 headache F А 39
16 62 F spondylolisthesis intraop decom & fu repair & Fi 2 399 G В numbness 31
17 62 F Stenosis intraop decom repair 3 574 E 83
18 62 F Stenosis intraop decom repair 2 165 dizziness & vomiting G 80
19 57 F Stenosis intraop decom & fu repair 2 291 G В numbness 39
20 52 F Stenosis intraop decom & fu Fi 6 1047 G А 22
21 54 F spondylolisthesis intraop decom & fu repair & Fi 4 1063 G В 34
22 66 F spondylolisthesis intraop decom & fu repair & Fi 5 1698 headache & nausea G А 33
23 36 F Stenosis intraop decom & fu repair & Fi 3 269 G А 12
24 78 M Stenosis intraop decom & fu repair & Fi 3 161 nausea E С 21
25 55 M spondylolisthesis intraop decom & fu Fi 3 392 E А 47
26 43 M revision intraop decom Fi 2 18 headache & nausea E 13
27 48 F revision intraop decom & fu repair & Fi 4 1066 headache G D 12
28 66 F spondylolisthesis intraop decom & fu repair & Fi 2 384 F С infection 12
29 27 M revision intraop decom repair & Fi 1 199 G 19
30 21 M revision postop decom & fu 5 539 G В 12
31 56 F spondylolisthesis intraop decom & fu repair & Fi 3 605 headache G А numbness 37
32 53 F revision postop decom & fu 6 1647 headache E В 22

Diagnosis;operation

Dura treatment

§ Total amount

|| Symtoms

Clinical result (E: excellent, G: good, F: fair)

∗∗ Radiographic result

†† Complications. follow up(months)

§§ decompression & fusion

|||| fibrin glue

¶¶ herniated neucleosus pulposus.

TOOLS
Similar articles