Reposing the herniated spinal nerves following accidental iatrogenic dural tear in spine surgery-The “no touch hip flexion technique”

Tewari, Vinod Kumar; Gupta, Hari Kishan Das

doi:10.4103/0976-3147.145245

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…Tewari and Gupta proposed another method to repose these nerve roots by using the “no touch hip flexion technique.” Without touching the nerve root or enlarging the vent, the herniated nerve roots are reposed indirectly by flexing the hip joint. By flexing the hip, intrathecal stretching of the nerves caused the herniated nerve roots to go inside spontaneously [10]. This technique will minimize further damage to the roots; however, it requires changing the position of the patient to semiprone on Jackson table or Wilson frame during the surgery, which could be quite troublesome for the surgical team members who are not familiar with this technique.…”

Section: Discussionmentioning

confidence: 99%

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Preservation and Tissue Handling Technique on Iatrogenic Dural Tear with Herniated Nerve Root at Cauda Equina Level

Rahyussalim

Djaja

Saleh

et al. 2016

Case Reports in Orthopedics

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Iatrogenic or incidental dural tear is a relatively common complication in lumbar decompression surgery. Although mostly there are no changes that occurred in long-term result following an incidental durotomy, the sequelae are not always benign especially when the herniated nerve root is involved. Preservation and tissue handling is paramount in order to prevent further injury. Two cases of dural tear with herniated nerve root complicating the lumbar decompression surgery are presented. Direct watertight repair was performed using the preservation and tissue handling concept. Assessing the relative size between the dural tear and the root mass is the key in determining whether enlargement of tear is needed. Whenever feasible, the tear will not be enlarged. Opening the vent by using a suture anchor and manually repositioning the nerve root with a fine instrument is the key for an atraumatic handling of the herniated nerve root. Clinical and neurophysiology examination was performed postoperatively and no further neurologic deficit occurred despite the iatrogenic injury. Although some debate on a few intraoperative and postoperative details still persists, tissue handling and preservation concept should be applied in all cases.

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Section: Discussionmentioning

confidence: 99%

“…Accordingly, atraumatic tissue handling is paramount in order to avoid further injury to the nerve [8]. …”

Section: Introductionmentioning

confidence: 99%