Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts

Background: Although dural tears (DTs) are known potential intraoperative complications of spine surgery, there is a relative lack of information about the true incidence of this common occurrence. Various studies have reported incidences ranging from 1.6%-17.4%. The literature on iatrogenic DT dur...

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Autor principal:	Wessam Soliman
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2015
Materias:	Incidental durotomy Dural tear Cerebrospinal fluid leak Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/f364be315eac44cdac80c43a7e640410
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spelling	oai:doaj.org-article:f364be315eac44cdac80c43a7e6404102021-12-02T03:27:18ZManagement of Incidental Lumbar Durotomy with Lumbar Drain and Fat GraftsDOI:10.21608/ESJ.2015.39492314-89502314-8969https://doaj.org/article/f364be315eac44cdac80c43a7e6404102015-01-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_3949.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background: Although dural tears (DTs) are known potential intraoperative complications of spine surgery, there is a relative lack of information about the true incidence of this common occurrence. Various studies have reported incidences ranging from 1.6%-17.4%. The literature on iatrogenic DT during spine surgery is surprisingly sparse; and the management is controversial. Purpose: To evaluate the use of lumbar drain and fat graft following incidental durotomy in prevention of early CSF leak and pseudomeningocele formation later on. Study Design: Prospective clinical case study. Patients and Methods: 343 patients were included in this study with degenerative spinal diseases indicated for decompression (lumbar disc, canal stenosis, degenerative spondylolisthesis or revision surgery). We excluded trauma cases and ventral tears not repaired. Patients with incidental dural tear had direct primary closure and then patients were divided into two groups: group A; a lumbar drains were inserted, and group B; a fat graft was used without drain. Both groups were followed-up for CSF leak control and pseudomeningocele formation. Results: We had 38 patients with DTs from 343 patients undergoing lumbar surgery with incidence of (11%). High incidence of DT occurred in revision surgeries (21.8%). In group (A), 85% of cases were free, 15% showed transient CSF leak managed conservatively, while in group (B), 72.2% were free, 27.7% showed transient CSF leak and 16.6% required repair for pseudomeningocele later on. Conclusion: Incidental durotomy is a well-known complication of spine surgery, and it occurs even among experienced spine surgeons. The use of lumbar drain was more efficient than fat graft in minimizing the postoperative CSF leak and pseudomeningocele formation. (2015ESJ078)Wessam SolimanEgyptian Spine AssociationarticleIncidental durotomyDural tearCerebrospinal fluid leakNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 13, Iss 1, Pp 27-34 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	Incidental durotomy Dural tear Cerebrospinal fluid leak Neurology. Diseases of the nervous system RC346-429
spellingShingle	Incidental durotomy Dural tear Cerebrospinal fluid leak Neurology. Diseases of the nervous system RC346-429 Wessam Soliman Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts
description	Background: Although dural tears (DTs) are known potential intraoperative complications of spine surgery, there is a relative lack of information about the true incidence of this common occurrence. Various studies have reported incidences ranging from 1.6%-17.4%. The literature on iatrogenic DT during spine surgery is surprisingly sparse; and the management is controversial. Purpose: To evaluate the use of lumbar drain and fat graft following incidental durotomy in prevention of early CSF leak and pseudomeningocele formation later on. Study Design: Prospective clinical case study. Patients and Methods: 343 patients were included in this study with degenerative spinal diseases indicated for decompression (lumbar disc, canal stenosis, degenerative spondylolisthesis or revision surgery). We excluded trauma cases and ventral tears not repaired. Patients with incidental dural tear had direct primary closure and then patients were divided into two groups: group A; a lumbar drains were inserted, and group B; a fat graft was used without drain. Both groups were followed-up for CSF leak control and pseudomeningocele formation. Results: We had 38 patients with DTs from 343 patients undergoing lumbar surgery with incidence of (11%). High incidence of DT occurred in revision surgeries (21.8%). In group (A), 85% of cases were free, 15% showed transient CSF leak managed conservatively, while in group (B), 72.2% were free, 27.7% showed transient CSF leak and 16.6% required repair for pseudomeningocele later on. Conclusion: Incidental durotomy is a well-known complication of spine surgery, and it occurs even among experienced spine surgeons. The use of lumbar drain was more efficient than fat graft in minimizing the postoperative CSF leak and pseudomeningocele formation. (2015ESJ078)
format	article
author	Wessam Soliman
author_facet	Wessam Soliman
author_sort	Wessam Soliman
title	Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts
title_short	Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts
title_full	Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts
title_fullStr	Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts
title_full_unstemmed	Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts
title_sort	management of incidental lumbar durotomy with lumbar drain and fat grafts
publisher	Egyptian Spine Association
publishDate	2015
url	https://doaj.org/article/f364be315eac44cdac80c43a7e640410
work_keys_str_mv	AT wessamsoliman managementofincidentallumbardurotomywithlumbardrainandfatgrafts
_version_	1718401769737814016

Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts

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