Evaluation of complication rates of pediatric spinal procedures in which a polyethylene glycol sealant was used

Goodwin, C. Rory; Recinos, Pablo F.; Xiao-fang, Zhou; Jm, Yang; Jallo, George I.

doi:10.3171/2013.12.peds13456

Cited by 9 publications

(14 citation statements)

References 20 publications

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“…Spinal intradural tumor resection surgeries carry 5-18% chance of CSF-related complications, including the development of CSF fistula, pseudomeningocele, and meningitis. The complications and their respective treatments of prolonged bed rest, re-operation, and extended use of antibiotics carry significant morbidity and mortality [10]. One of the most widely used treatments for spinal CSF leak is direct suture repair of the dural tear, with a still significant failure rate of 5-9% [1].…”

Section: Discussionmentioning

confidence: 99%

Repair of Postoperative Cervical Pseudomeningocele with the Use of Bone Morphogenetic Protein

Slavnic

McCabe

Tong

et al. 2019

Cureus

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Recurrent cerebrospinal fluid (CSF) leak carries significant morbidity and mortality. A 25-year-old Caucasian male developed a symptomatic pseudomeningocele eight days after surgical resection of a cervical schwannoma. With no improvement after lumbar drain placement, the dural sleeve defect over the left C3 nerve root was repaired with suturable DuraGen® (Integra LifeSciences, Plainsboro, NJ, USA). Muscle and fat graft were then laid over the repair site and covered by Tisseel® (Baxter Healthcare, Deerfield, IL, USA). Recombinant human bone morphogenetic protein-2 (rhBMP-2) was applied via extra-small sponge laid over the graft. At 15-month clinical and 16-month radiographic follow-up, the patient had complete resolution of symptoms without any evidence of infection, ectopic bone formation, excessive inflammation, neoplasm, or recurrent CSF leak. This case demonstrates the successful use of BMP in the treatment of recurrent symptomatic cervical pseudomeningocele after tumor resection. We believe that the pro-inflammatory effects of rhBMP-2 lead to early scarring of dural defect and resolution of CSF leak.

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Section: Discussionmentioning

confidence: 99%

Repair of Postoperative Cervical Pseudomeningocele with the Use of Bone Morphogenetic Protein

Slavnic

McCabe

Tong

et al. 2019

Cureus

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“…4 When durotomies occur, there are a number of accepted ways to repair them, from direct repair with suture, to the overlay of newer compounds designed to seal off the dural rent. 6,7,12 Ultimately, the optimum method for repair depends primarily on not only the anatomical location of the durotomy, but also the mechanism by which it occurred. In the adult literature, durotomies typically occur during decompression of the thecal sac.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, few studies have sought to examine the overall incidence of durotomy in the pediatric population and what factors, if any, seem to influence this. 4,7 This is a rather important research question because the indications for pediatric spinal surgery as well as the anatomical landscape of pediatric spine surgery are quite different than those for the majority of adult cases, which tend to involve degenerative spinal disease such as herniated lumbar disc or lumbar spinal stenosis.…”

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confidence: 99%

Incidental durotomy in the pediatric spine population

West¹,

Arnel²,

Palma³

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVESpine surgery is less common in children than adults. These surgeries, like all others, are subject to complications such as bleeding, infection, and CSF leak. The rate of incidental durotomy in the pediatric population, and its associated complications, has scarcely been reported in the literature.METHODSThis is a retrospective chart review of all pediatric patients operated on at Wake Forest Baptist Health from 2012 to 2017 who underwent spine surgeries. The authors excluded any procedures with intended durotomy, such as tethered cord release or spinal cord tumor resection.RESULTSFrom 2012 to 2017, 318 pediatric patients underwent surgery for a variety of indications, including adolescent idiopathic scoliosis (51.9%), neuromuscular scoliosis (27.4%), thoracolumbar fracture (2.83%), and other non–fusion-related indications (3.77%). Of these patients, the average age was 14.1 years, and 71.0% were female. There were 6 total incidental durotomies, resulting in an overall incidence of 1.9%. The incidence was 18.5% in revision operations, compared to 0.34% for index surgeries. Comparison of the revision cohort to the durotomy cohort revealed a trend toward increased length of stay, operative time, and blood loss; however, the trends were not statistically significant. The pedicle probe was implicated in 3 cases and the exact cause was not ascertained in the remaining 3 cases. The 3 durotomies caused by pedicle probe were treated with bone wax; 1 was treated with dry Gelfoam application and 2 were treated with primary repair. Only 1 patient had a persistent leak postoperatively that eventually required wound revision.CONCLUSIONSIncidental durotomy is an uncommon occurrence in the pediatric spinal surgery population. The majority occurred during placement of pedicle screws, and they were easily treated with bone wax at the time of surgery. Awareness of the incidence, predisposing factors, and treatment options is important in preventing complications and disability.

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“…Two recent studies ( 10 , 33 ) evaluated the efficacy of polyethylene glycol sealants in an attempt to decrease the rate of CSF-related complications after intradural spinal surgery. Goodwin and colleagues ( 10 ) reported that CSF leaks occurred in 5% of patients and meningitis occurred in 1%. Similarly, Wright and associates ( 33 ) compared the use of polyethylene glycol sealant to the standard of care dural closure.…”

Section: Discussionmentioning

confidence: 99%

CSF-Related Complications After Intradural Spinal Tumor Surgery: Utility of an Autologous Fat Graft

Arnautović

Kovačević

2016

Med Arh

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Object:The incidence of cerebrospinal fluid (CSF)-related complications after intradural spinal tumor (IST) surgery is high and reported in up to 18% of patients. However, no efficient way to prevent those complications has been reported so far. Treating these complications may require prolonged bed rest, re-exploration, external lumbar drain, use of antibiotics, and possible precipitation of other complications. To alleviate the risk of CSF-related complications, we prospectively adopted the intraoperative use of autologous fat grafting after IST surgery.Methods:This is a perspective analysis of 37 cases (out of 40 cases series) that a prospective use of abdominal fat autograft was applied during dural closure. After the tumor was resected and the dura closed, we used the Valsalva maneuver to ensure watertight closure. CSF leak was prevented with the enforcement of suture with a fat autograft as necessary. In addition a thin layer of fat tissue was then placed over the dura to obliterate any dead space. Fibrin glue was then applied over the graft. Filling the dead space with the fat graft prevented a low-pressure space in which CSF could pool and form a pseudomeningocele.Results:After adopting the fat autograft technique, we did not observe any post-surgery CSF-related complications in any of these patients.Conclusions:The prospective use of autologous fat grafting can ensure watertight dural closure and obliterate the dead space created during surgical exposure and bone removal. This technique significantly reduces, and may completely eliminate, postoperative CSF-related complications in patients with ISTs.

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Evaluation of complication rates of pediatric spinal procedures in which a polyethylene glycol sealant was used

Cited by 9 publications

References 20 publications

Repair of Postoperative Cervical Pseudomeningocele with the Use of Bone Morphogenetic Protein

Repair of Postoperative Cervical Pseudomeningocele with the Use of Bone Morphogenetic Protein

Incidental durotomy in the pediatric spine population

CSF-Related Complications After Intradural Spinal Tumor Surgery: Utility of an Autologous Fat Graft

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