Accidental Dural Tears in Minimally Invasive Spinal Surgery for Degenerative Lumbar Spine Disease

Aspalter, Stefan; Senker, Wolfgang; Radl, Christian; Aichholzer, Martin; Aufschnaiter-Hießböck, Kathrin; Leitner, Clemens; Stroh, Nico; Trutschnig, Wolfgang; Gruber, Andreas; Stefanits, Harald

doi:10.3389/fsurg.2021.708243

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…The prevalence was variable across age groups, and it was much higher in older patients above the age of 60 years (17.2%). Previous studies support this finding [ 12 , 13 ]. Aging is a complex process associated with degenerative changes in the spine.…”

Section: Discussionsupporting

confidence: 79%

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Incidental Dural Tears During Lumbar Spine Surgery: Prevalence and Evaluation of Management Outcomes

Alessa,

Ababneh,

Al Taimeh

et al. 2024

Cureus

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Introduction: Incidental dural tears (IDTs) are sometimes observed as an intraoperative complication associated with lumbar spine surgery. Commonly, this complication is recognized and repaired during surgery, but if it is undiagnosed or inadequately treated, a variety of consequences may occur. Many techniques have been developed to treat cerebrospinal fluid (CSF) leakage, and each has its limitations. Objectives: To assess the prevalence of incidental dural tears in lumbar spine surgeries and evaluate the outcomes of the sandwich technique in the management of this complication. Methods: A total of 92 patients who underwent lumbar spine surgery at the Royal Rehabilitation Center in Amman from January 2018 to December 2021 were retrospectively reviewed. Patients were divided into two groups: group A (patients without IDT) and group B (patients with IDT), where group B was repaired using the sandwich technique. The follow-up period was six months. Further, the sandwich technique involves repairing the dural defect with interlocking sutures, painting medical glue around the dural incision, covering this with gelatin sponge, and finally covering the gelatin sponge with medical glue again. Results: The overall prevalence of IDT in the study group was 14.1%. IDT was more common among elderly patients above the age of 60 (17.2%), females (16.7%), patients with multiple lumbar levels treated (66.7%), open approaches (21%), and those who had previous spinal surgery (72.7%). Most IDTs were diagnosed and managed intraoperatively (84.6%). Among those patients, only one complained of a surgical site infection. Patients in group B had a significantly higher postoperative length of hospital stay, amount of drainage, and operative time compared to group A (P<0.001). Regarding postoperative pain, patients in group B had significantly higher pain on the Numerical Pain Scale at day three post-operation compared to patients in group A (P<0.001). Conclusion: Based on our results, the sandwich technique was effective in the management and prevention of CSF leakage. Further prospective studies with long-term follow-up are needed to confirm our findings.

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Section: Discussionsupporting

confidence: 79%

“…The influence of previous surgery on the increased rate of IDT is well studied [ 2 , 12 , 13 ]. The findings of our analysis were in concordance with the previous literature.…”

Section: Discussionmentioning

confidence: 99%

Incidental Dural Tears During Lumbar Spine Surgery: Prevalence and Evaluation of Management Outcomes

Alessa,

Ababneh,

Al Taimeh

et al. 2024

Cureus

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“…First, this case reminded us that whether in the process of open surgery or minimally invasive surgery, we should carefully separate the adhesions and operate carefully to try to avoid CSF leakage due to dural tears. Second, if CSF leakage occurs after surgery, the drainage time should be appropriately extended, and sufficient drainage should be carried out to avoid the formation of dead space, which can facilitate bacterial infections ( 12 ). Third, when removing the drainage tube of patients with CSF leakage after surgery, we should routinely send the drainage fluid for analysis and culture to provide us with the treatment direction when there is a bacterial infection.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Bacterial meningitis due to cerebrospinal fluid leakage following unilateral biportal endoscopic spinal surgery: a cautionary tale

Wang,

Jiang

et al. 2024

Front. Surg.

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Unilateral biportal endoscopic spinal surgery (UBE) is a rapidly growing surgical method and has attracted much interest recently. The most common complication of this technique is cerebrospinal fluid (CSF) leakage due to intraoperative dural tears. There have been no reports of bacterial meningitis due to dural tears in UBE surgery and its treatment and prevention. We reported a 47 year-old man with CSF due to an intraoperative dural tear. A drainage tube was routinely placed and removed on the fourth day after surgery, resulting in fever and headache on the fifith postoperative day. Blood and CSF cultures showed Klebsiella pneumoniae infection, and with lumbar drainage and appropriate antibiotics based on sensitivity tests, the patient's fever and headache were effectively relieved. This case report suggests the importance of prolonged drainage tube placement, adequate drainage, careful intraoperative separation to avoid dural tears, and effective sensitive antibiotic therapy.

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“…Similar to other reports [8,13], operative time in our series also reduced over time with experience. The incidence of dural tear in MIS-TLIF reported in the literature varies between 3 and 12% [14,15,16].…”

Section: Discussionmentioning

confidence: 99%

MIS-TLIF: Technical note, Learning goals behind case selection during early part of learning curve and clinical outcomes in first 150 cases

Srikantha¹,

Perikal²,

Hari³

et al. 2022

Jcorth

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Introduction: Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) has been shown to offer several advantages over conventional (open) TLIF and is being increasingly employed by young surgeons early in their careers. It is important to know the appropriate technique and the correct cases to be selected in the early phase to achieve good outcomes during the learning curve. A detailed and illustrative technical note along with a guide for case selection at different phases of experience has been presented in this article. Methods: The first consecutive single surgeon series of 150 MIS-TLIF cases done over 4 years between 2012 and 2015 were considered for analysis. Demographic and peri-operative data and previously documented follow-up were collected from case records. Telephonic questionnaire and consultation were done to collect latest status, any procedures/surgeries done elsewhere for issues related to index procedure. Results were stratified as Group 1 – first 25 cases; Group 2 – 26–75 cases; Group 3 – 76–150 cases. Results: The major indication for surgery in group 1 was either Grade 1 spondylolisthesis or lumbar canal stenosis with concomitant axial symptoms. The incidence of relatively complex cases (Grade 2 or 3 listhesis; Revision cases; Multilevel cases) increased with each successive group. As expected, the operative time (calculated for only single-level cases) improved with time. The overall rate of peri-operative complications was higher in group 2 as compared to groups 1 and 3, predominantly due to an increased incidence of intra-operative dural tears in group 2. Symptomatic screw malposition was detected in five screws, all were managed conservatively. The median duration of follow-up for the entire group was 39 months (Range – 1–119 months). Eighty-two (55%) patients had follow-up of more than 1 year while 31 (20.6%) patients had follow-up of more than 7 years. Around 80–85% of patients at each point of follow-up assessment had a successful outcome (McNab 4 and 5). The re-operation rate for index level problems or adjacent segment was 2.6%, only one of which was done at the author’s center. Conclusions: Minimally invasive TLIF is a safe and effective procedure with favorable long-term results and acceptable complication rates. Though technically challenging in initial phases, a good understanding of the technique and principles of minimally invasive spine surgery along with fulfilling helpful pre-requisites and appropriate case selection as mentioned in this article, will help to smoothen the learning curve and avoid unfavorable outcomes in early stages.

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Accidental Dural Tears in Minimally Invasive Spinal Surgery for Degenerative Lumbar Spine Disease

Cited by 9 publications

References 31 publications

Incidental Dural Tears During Lumbar Spine Surgery: Prevalence and Evaluation of Management Outcomes

Incidental Dural Tears During Lumbar Spine Surgery: Prevalence and Evaluation of Management Outcomes

Case Report: Bacterial meningitis due to cerebrospinal fluid leakage following unilateral biportal endoscopic spinal surgery: a cautionary tale

MIS-TLIF: Technical note, Learning goals behind case selection during early part of learning curve and clinical outcomes in first 150 cases

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