Predisposing factors for dural tear in patients undergoing lumbar spine surgery

Smorgick, Yossi; Baker, Kevin C.; Herkowitz, Harry N.; Montgomery, David; Badve, Siddharth A; Bachison, Casey; Ericksen, Steven; Fischgrund, Jeffrey S.

doi:10.3171/2015.1.spine13864

Cited by 62 publications

(48 citation statements)

References 13 publications

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“…The durotomy incidence in a group of patients who underwent revision surgery was 25% (29 of 116) and was not associated with the years of experience of the surgeon performing the procedure. 38 Studies entirely composed of interbody fusion procedures, such as those conducted by Mehta et al 28 and Tormenti et al, 42 reported higher durotomy rates of 14.2% and 14.3%, respectively. The highest durotomy rate, 20%, was reported in a non-cohort-matched prospective study by Rodriguez-Olaverri and colleagues in which the authors evaluated clinical and radiographic outcomes of instrumented fusion for high-grade spondylolisthesis.…”

Section: Open Lumbar Proceduresmentioning

confidence: 99%

Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

Ghobrial

Theofanis

Darden

et al. 2015

FOC

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OBJECT Unintended durotomy is a common occurrence during lumbar spinal surgery, particularly in surgery for degenerative spinal conditions, with the reported incidence rate ranging from 0.3% to 35%. The authors performed a systematic literature review on unintended lumbar spine durotomy, specifically aiming to identify the incidence of durotomy during spinal surgery for lumbar degenerative conditions. In addition, the authors analyzed the incidence of durotomy when minimally invasive surgical approaches were used as compared with that following a traditional midline open approach. METHODS A MEDLINE search using the term “lumbar durotomy” (under the 2015 medical subject heading [MeSH] “cerebrospinal fluid leak”) was conducted on May 13, 2015, for English-language medical literature published in the period from January 1, 2005, to May 13, 2015. The resulting papers were categorized into 3 groups: 1) those that evaluated unintended durotomy rates during open-approach lumbar spinal surgery, 2) those that evaluated unintended durotomy rates during minimally invasive spine surgery (MISS), and 3) those that evaluated durotomy rates in comparable cohorts undergoing MISS versus open-approach lumbar procedures for similar lumbar pathology. RESULTS The MEDLINE search yielded 116 results. A review of titles produced 22 potentially relevant studies that described open surgical procedures. After a thorough review of individual papers, 19 studies (comprising 15,965 patients) pertaining to durotomy rates during open-approach lumbar surgery were included for analysis. Using the Oxford Centre for Evidence-Based Medicine (CEBM) ranking criteria, there were 7 Level 3 prospective studies and 12 Level 4 retrospective studies. In addition, the authors also included 6 studies (with a total of 1334 patients) that detailed rates of durotomy during minimally invasive surgery for lumbar degenerative disease. In the MISS analysis, there were 2 prospective and 4 retrospective studies. Finally, the authors included 5 studies (with a total of 1364 patients) that directly compared durotomy rates during open-approach versus minimally invasive procedures. Studies of open-approach surgery for lumbar degenerative disease reported a total of 1031 durotomies across all procedures, for an overall durotomy rate of 8.11% (range 2%–20%). Prospectively designed studies reported a higher rate of durotomy than retrospective studies (9.57% vs 4.32%, p = 0.05). Selected MISS studies reported a total of 93 durotomies for a combined durotomy rate of 6.78%. In studies of matched cohorts comparing open-approach surgery with MISS, the durotomy rates were 7.20% (34 durotomies) and 7.02% (68), respectively, which were not significantly different. CONCLUSIONS Spinal surgery for lumbar degenerative disease carries a significant rate of unintended durotomy, regardless of the surgical approach selected by the surgeon. Interpretation of unintended durotomy rates for lumbar surgery is limited by a lack of prospective and cohort-matched controlled studies.

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Section: Open Lumbar Proceduresmentioning

confidence: 99%

Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

Ghobrial

Theofanis

Darden

et al. 2015

FOC

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“…Surgical invasiveness and manipulation of dura has been reported as a general predictor of dural injury and appears to be associated with overall dural injury rates. Dural injury incidence in a group of patients who underwent revision surgery was 25% and was not associated with the years of experience of the surgeon (16) . In our study, the ratio of dural injury in revision cases was found to be 25.86% (15/58).…”

Section: Discussionmentioning

confidence: 87%

Unintended Dural Injury in Degenerative Lumbar Spinal Surgery: A Retrospective Study

Çivi¹

2020

jtss

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Unintended dural injury is a common complication during degenerative lumbar spinal surgery. Dural injury rate in all spinal surgeries is between 0.2% and 20% (1-4). Unintended dural injury increases with increasing age, female sex, surgical experience, invasive surgery, revision surgery and degenerative process. In degenerative process, this rate approaches the upper limits. The average rate is 17% (4,5-9). Cerebrospinal fluid (CSF) leakage caused by dural injury may complicate the postoperative period with headaches, nausea, vomiting, back pain, abducens nerve palsy, fistula formation, pseudomeningocele, surgical site infections, meningitis, and in rare circumstances, chronic subdural hematomas (10-15) .However, these complications can be handled by developing surgical techniques. In this study, we aimed to retrospectively evaluate the causes and consequences of unintended dural injury. MATERIALS AND METHODS Patients All patients who underwent spine surgery for degenerative conditions performed at our institution between 2011 and 2018 were included in the study. We excluded patients treated for tumors, infections, and deformity from this study. This retrospective study included 376 adult patients (225 female and 151 male) who had undergone decompression and posterior lumbar pedicle screw fixation. Study Approval The need for informed consent was waived owing to the retrospective nature of the study. Surgical Technique All patients in the study underwent decompression and pedicular screw fixation due to the degenerative process. Dural

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“…Fortunately in the last decades, the prevalence of dural tears was decreased due to the increasing experience of spine surgeons, when performing minimal invasive techniques such as FED. All authors conclude that the key point is the prevention and the immediate recognition and treatment, in order to avoid the long-term sequelae of dural tears [40]. Fig.…”

Section: Discussionmentioning

confidence: 95%

Full Endoscopic Discectomy Using Transforaminal Endoscopic Spine System Technique: A Mini Review of Complications

Kapetanakis¹,

Chaniotakis²,

Angoules³

2019

TOORTHJ

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Background:Full Endoscopic Discectomy (FED) is a minimally invasive technique for the treatment of Lumbar Disk Herniation (LDH) with increasing popularity among surgeons in the recent years. This alternative to conventional procedures surgical approach is generally a safe and efficient technique possessing many advantages such as less soft tissue trauma, preservation of dorsal musculature, and reduced perioperative morbidity and rapid recovery. However, FED is associated with a number of complications such as postoperative dysesthesia, nerve root injury, and dural tears.Methods:Α search of PubMed, Google Scholar and Scopus electronic databases was used to revised the literature on complications of full endoscopic discectomy using transforaminal endoscopic spine system techniqueConclusion:In this review complications associated with FED are analyzed, emphasizing on the potential beneficial role of Transforaminal Endoscopic Spine System (TESSYS) technique in reducing their frequency.

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Predisposing factors for dural tear in patients undergoing lumbar spine surgery

Cited by 62 publications

References 13 publications

Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

Unintended Dural Injury in Degenerative Lumbar Spinal Surgery: A Retrospective Study

Full Endoscopic Discectomy Using Transforaminal Endoscopic Spine System Technique: A Mini Review of Complications

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