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

Journal of Korean Spine Surg 2002;9(3):191-196.

Published online: 21 February 2002

DOI: https://doi.org/10.4184/jkss.2002.9.3.191

Dural Tears Secondary to Operations of the Lumbar Spinal Disorders

Ki Soo Kim, M.D., Yong Soo Choi, M.D., Do Yong Kim, M.D., Yang Min Chung, M.D., In Seok Park, M.D., Bong Hee Park, M.D.

Department of Orthopaedic Surgery, Gwangju Christian Hospital, Gwangju, Korea

Address reprint requests to Yong-Soo Choi, M.D. Department of Orthopaedic Surgery, Gwangju Christian Hospital #264, Yanglim-dong, Nam-gu, Gwangju 503-040, Korea Tel : 82-62-650-5064, Fax : 82-62-650-5066, E-mail : yschoi2@kwangju.md

Copyright © 2002 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Lumbar spine, Dural tear, Treatment

REFERENCES

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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.

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