Abstract
Study design
Case control series with prospective data collection.
Objective
To establish whether incidental durotomy treated without primary suture repair adversely affects the outcome following lumbar surgery in the longer term.
Method
Outcome scores from a prospective database were used for an audit of dural tears in primary lumbar decompressive surgery. Outcome data collected includes the Short Form 36 General Health Questionnaire (SF36), the Oswestry Disability Index (ODI) and Visual Analogue Scores for leg pain (VAL) and back pain (VAB).
Results
Out of 200 consecutive procedures, a dural tear occurred in 19 (9.5 %) patients. Of 19 patients with a dural tear, data was incomplete in 4 patients, and 1 further patient who had their dural tear sutured was excluded, leaving 14 patients to be studied. There were seven males and seven females, with an average age of 50.8 years (31–69). These 14 patients (group 1) were compared to a matched group (age, sex, surgical diagnosis and duration of follow-up) of 14 patients (group 2) with no tear. Both groups had similar pre-operative scores. At 6-month follow-up, both groups had significant improvements in all outcomes measures except for the general health domain of the SF-36. At final follow-up, patients with dural tears appeared to have better improvements in outcome measures amongst the VAB, VAL and ODI with similar scores in the SF-36 domains.
Conclusion
Our study demonstrates that incidental durotomy in primary lumbar decompressive surgery can be successfully managed without primary suture repair with no adverse effect on surgical outcome in the longer term.
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References
Eismont FJ, Wiesel SW, Rothman R (1981) Treatment of dural tears associated with spinal surgery. JBJS (Am) 63-A:1132–1136
Finnegan W, Fenlin J, Marvel J, Nardini R, Rothman R (1979) Results of surgical intervention in the symptomatic multiply-operated back patient. Analysis of 67 cases followed for 3 to 7 years. JBJS (Am) 61-A:1077–1082
Jones A, Stambough J, Balderston R, Rothman R, Booth R (1989) Longterm results of lumbar spine surgery complicated by unintended incidental durotomy. Spine 14:443–446
Kitchel S, Eismont F, Green B (1989) Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. JBJS (Am) 71-A:984–987
Tafazal S, Sell P (2005) Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J 14(3):287–290
Saxler G, Kramer J, Barden B, Kurt A, Pfortner J, Bernsmann K (2005) The longterm clinical sequelae of incidental durotomy in lumbar disc surgery. Spine 30(20):2298–2302
Brookfield K, Randolph J, Eismont F, Brown M (2008) Delayed symptoms of cerebrospinal fluid leak following lumbar decompression. Orthopaedics 31(8):816
Bosacco SJ, Gardner BA, Guille JT (2001) Evaluation and treatment of dural tears in lumbar spine surgery. Clin Orthop Relat Res 389:238–247
Narotam PK, Jose S, Nathoo N, Taylon C, Vora Y (2004) Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine 29(24):2861–2867
Guerin P et al (2012) Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury 43(4):397–401
Szpalski M, Gunzburg R, Sztern B (2004) An overview of blood-sparing techniques used in spine surgery during the perioperative period. Eur Spine J 13(Suppl 1):S18–S27
Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty eight patients. JBJS (Am) 80:1728–1732
Stromqvist F, Jonsson B, Stromqvist B (2010) Dural lesions in lumbar disc herniation surgery: incidence, risk factors and outcome. Eur Spine J 19:439–442
Hodges SD, Humphreys SC, Eck JC, Covington LA (1999) Management of incidental durotomy without mandatory bed rest. A retrospective review of 20 cases. Spine 24(19):2062–2064
Than KD, Wang AC, Etame AB, La Marca F, Park P (2008) Postoperative management of incidental durotomy in minimally invasive lumbar spinal surgery. Minim Invasive Neurosurg 51(5):263–266
Radcliff KE, Sidhu GD, Kepler CK, Gruskay J, Anderson DG, Hilibrand A, Albert TJ, Vaccaro AR (2013) Complications of flat bedrest following incidental dural repair. J Spinal Disord Tech (Epub ahead of print)
Cammisa FP Jr, Girardi FP, Sangani PK et al (2000) Incidental durotomy in spine surgery. Spine 25:2663–2667
Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P, Cheng BC, Faught R, Welch WC (2009) Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J 18(8):1169–1174
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Grannum, S., Patel, M.S., Attar, F. et al. Dural tears in primary decompressive lumbar surgery. Is primary repair necessary for a good outcome?. Eur Spine J 23, 904–908 (2014). https://doi.org/10.1007/s00586-013-3159-9
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DOI: https://doi.org/10.1007/s00586-013-3159-9