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Abstract
Objectives
To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD).
Summary of Literature Review
The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified.
Materials and Methods
A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures.
Results
In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably.
REFERENCES
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Fig. 1.
Magnetic resonance imaging (MRI) findings. (A, B) T2-weighted MRI images showing hyperintense signal changes in the annulus fibrosus at the previous discectomy site (arrow, sagittal view; arrowhead, axial view). (C, D) Gd-enhanced T1-weighted images showing mild enhancement of the annulus fibrosus at the previous discectomy site (arrow, sagittal view; arrowhead, axial view). Nerve root sleeve violation by the disc material was not observed.
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