Spinal Dural Repair: A Canadian Questionnaire

Oitment, Colby; Aref, Mohammed; Almenawar, Saleh; Reddy, Kesava

doi:10.1177/2192568217724132

Cited by 19 publications

(7 citation statements)

References 23 publications

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“…Based on the defects of a single treatment strategy, two or a combination of two schemes is often used in the clinic. A Canadian questionnaire showed that, as the size of the defect gradually increases, clinicians gradually adopt a combination of treatment regimens[ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Late presentation of dural tears: Two case reports and review of literature

Chen¹,

Dong²,

Cheng³

et al. 2023

World J Clin Cases

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BACKGROUND The late presentation of dural tears (LPDT) has a low incidence rate and hidden symptoms and is easily ignored in clinical practice. If the disease is not treated in time, a series of complications may occur, including low intracranial pressure headache, infection, pseudodural cyst formation, and sinus formation. Here, we describe two cases of LPDT. CASE SUMMARY Two patients had sudden fever 1 wk after lumbar surgery. Physical examination showed obvious tenderness in the operation area. The patients were confirmed as having LPDT by lumbar magnetic resonance imaging and surgical exploration. One case was caused by continuous negative pressure suction and malnutrition, and the other was caused by decreased dural ductility and low postoperative nutritional status. The first symptom of both patients was fever, with occasional headache. Both patients underwent secondary surgery to treat the LPDT. Dural defects were observed and dural sealants were used to seal the dural defects, then drainage tubes were retained for drainage. After the operation, the patients were treated with antibiotics and the patients’ surgical incisions healed well, without fever or incision tenderness. Both recovered and were discharged 1 wk after the operation. CONCLUSION LPDT is a rare complication of spinal surgery or neurosurgery that has hidden symptoms and can easily be overlooked. Since it may cause a series of complications, LPDT needs to be actively addressed in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Late presentation of dural tears: Two case reports and review of literature

Chen¹,

Dong²,

Cheng³

et al. 2023

World J Clin Cases

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“…Although the recent literature reports encouraging results with suture-less dural repair [ 23 , 24 ], the direct suture remains the preferred method. Therefore, despite the inaccessible location, primary suturing or other strategies ensuring watertightness should be pursued even for sealing off anterior dural tears.…”

Section: Discussionmentioning

confidence: 99%

Anterior Dural Tear in Thoracic and Lumbar Spinal Fractures: Single-Center Experience with Coating Technique and Literature Review of the Available Strategies

Lofrese

Visani

Cultrera

et al. 2021

Life

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Differently from the posterior, the anterior dural tears associated with spinal fractures are rarely reported and debated. We document our experience with a coating technique for repairing ventral dural lacerations, providing an associated literature review on the available strategies to seal off such dural defects. A PubMed search on watertight repair techniques of anterior dural lacerations focused on their association with spinal fractures was performed. Studies on animal or cadaveric models, on cervical spine, or based on seal/gelfoam or “not suturing” strategies were excluded. 10 studies were finally selected and our experience of three patients with thoracic/lumbar spinal fractures with associated ventral dural tear was integrated into the analysis of the surgical techniques. Among the described repair techniques for ventral dural lacerations a preference for primary suturing, mostly trans-dural, was noted (n = 6/10 papers). Other documented strategies were the plugging of the dural opening with a fat graft sutured to its margins, or stitched to the dura adjacent to the defect, and the closure of the dural tear with two patches, both trans-dural and epidural. Our coating techniques of the whole dural sac with the heterologous patch were revealed as safe and effective alternatives strategies, even when patch flaps wrapping nerve roots have to be cut and a fat graft has to be stitched in the patch respectively for sealing off antero-lateral and wide anterior dural tears. Compared to all the documented strategies for obtaining a watertight closure of an anterior dural laceration, the coating techniques revealed advantages of preserving neural structures, being adaptable to anterior and antero-lateral dural tears of any size.

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“…In a survey of Canadian neurosurgeons conducted by our group, the majority of respondents indicated they would use suture repair for medium to large size durotomy, whereas 36.7% would only use sealant in case of pinhole tear. 23 Similarly, 50% would use dural sealant for anterior and nerve root dural tear, likely because of the technical difficulty in closing durotomies at these locations. This is essentially true for MISS because the room for instrument manipulation is limited by the narrow tubes.…”

Section: Discussionmentioning

confidence: 99%

Safety of Early Mobilization in Patients With Intraoperative Cerebrospinal Fluid Leak in Minimally Invasive Spine Surgery: A Case Series

Aljoghaiman¹,

Ellenbogen²,

Takroni³

et al. 2021

Operative Surg.

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BACKGROUND Cerebrospinal fluid (CSF) leak is a common complication in spine surgery. Repairing durotomy is more difficult in the setting of minimally invasive spine surgery (MISS). Efficacy of postoperative bed rest in case of dural tear in MISS is not clear. OBJECTIVE To assess the safety and efficacy of our protocol of dura closure without changing access, early mobilization, and discharge in cases of intraoperative CSF leak in MISS. METHODS A retrospective review from 2006 to 2018 of patients who underwent MISS for degenerative and neoplastic diseases with documented accidental or intentional durotomy was conducted. The primary outcome of interest was readmission rate for repair of persistent CSF leak. Secondary outcomes captured included development of pseudomeningocele, positional headache, and subdural hematoma. RESULTS A total of 80 patients were identified out of 527 patients. Of these, intentional durotomy was performed in 28 patients and unintentional durotomy occurred in 52 patients. Mean follow-up period was 80.6 mo. Most of the patients were discharged on postoperative day 0 (within 4 h of surgery) without activity restrictions. A total of 2 (2.5%) patients required readmission and dural repair for continuous CSF leak and 3 patients (3.75%) developed pseudomeningocele. No lumbar drain insertion, meningitis, or subdural hematoma was reported. CONCLUSION Early mobilization and discharge in cases of intraoperative CSF leak in MISS appear to be safe and not associated with higher rate of complications than that of reported literature.

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Spinal Dural Repair: A Canadian Questionnaire

Cited by 19 publications

References 23 publications

Late presentation of dural tears: Two case reports and review of literature

Late presentation of dural tears: Two case reports and review of literature

Anterior Dural Tear in Thoracic and Lumbar Spinal Fractures: Single-Center Experience with Coating Technique and Literature Review of the Available Strategies

Safety of Early Mobilization in Patients With Intraoperative Cerebrospinal Fluid Leak in Minimally Invasive Spine Surgery: A Case Series

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