Cerebrospinal fluid leaks following spinal surgery: use of fat grafts for prevention and repair

Black, Perry

doi:10.3171/spi.2002.96.2.0250

Cited by 68 publications

(58 citation statements)

References 3 publications

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“…5,6,9,15,32,50,57 Dural tears are likely to occur when the dura becomes ossified and adheres to the PLL and cannot be dissected off. 11 Such dural tears create tissue gaps that are not amenable to primary repair.…”

Section: Intraoperative Strategiesmentioning

confidence: 99%

Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Mazur¹,

Jost²,

Schmidt³

et al. 2011

FOC

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Object Anterior decompression is an effective way to treat cervical myelopathy associated with ossification of the posterior longitudinal ligament (OPLL); however, this approach is associated with an increased risk of a dural tear and resultant CSF leak because fusion of the dura with the ossified PLL is common in these cases. The authors review the literature and present an algorithm for treatment of CSF leaks in these patients. Methods A MEDLINE review was performed to identify papers related to CSF leak after anterior decompression for OPLL, and data were summarized to identify treatment options for various situations. A treatment algorithm was identified based on these findings and the experience of the authors. Results Eleven studies were identified that presented data on intra- and postoperative management of a CSF leak during ventral surgery for OPLL. The incidence of cervical dural tears and CSF leaks after anterior decompression procedures for OPLL ranged from 4.3% to 32%. Techniques including preventative measures, intraoperative dural repair with various materials, and postoperative drainage or shunt placement have all been used. Conclusions Although direct dural repair is the preferred treatment for CSF leak, this technique is not always technically possible. In these cases, intraoperative adjuncts in combination with postoperative measures can be used to decrease the pressure gradient across the dural tear.

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Section: Intraoperative Strategiesmentioning

confidence: 99%

Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Mazur¹,

Jost²,

Schmidt³

et al. 2011

FOC

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“…Various series have estimated the incidence of an unintentional durotomy during lumbar spine surgery to be between 1 and 17%, 1,2,4,9,12–19,21–27,30 with higher incidences associated with repeat surgery, increased patient age and reduced surgeon experience. 4,7–9,13,25,27 …”

Section: Introductionmentioning

confidence: 99%

Outcomes after incidental durotomy during first-time lumbar discectomy

Desai¹,

Ball²,

Bekelis³

et al. 2011

SPI

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Object Incidental durotomy is an infrequent but well-recognized complication during lumbar disc surgery. The effect of a durotomy on long-term outcomes is, however, controversial. The authors sought to examine whether the occurrence of durotomy during surgery impacts long-term clinical outcome. Methods Spine Patient Outcomes Research Trial (SPORT) participants who had a confirmed diagnosis of intervertebral disc herniation and were undergoing standard first-time open discectomy were followed up at 6 weeks and at 3, 6, and 12 months after surgery and annually thereafter at 13 spine clinics in 11 US states. Patient data from this prospectively gathered database were reviewed. As of May 2009, the mean (± SD) duration of follow-up among all of the intervertebral disc herniation patients whose data were analyzed was 41.5 ± 14.5 months (41.4 months in those with no durotomy vs 40.2 months in those with durotomy, p < 0.68). The median duration of follow-up among all of these patients was 47 months (range 1–95 months). Results A total of 799 patients underwent first-time lumbar discectomy. There was an incidental durotomy in 25 (3.1%) of these cases. There were no significant differences between the durotomy and no-durotomy groups with respect to age, sex, race, body mass index, herniation level or type, or the prevalence of smoking, diabetes, or hypertension. When outcome differences between the groups were analyzed, the durotomy group was found to have significantly increased operative duration, operative blood loss, and length of inpatient stay. However, there were no significant differences in incidence rates for nerve root injury, postoperative mortality, additional surgeries, or SF-36 scores for Bodily Pain or Physical Function, or Oswestry Disability Index scores at 1, 2, 3, or 4 years. Conclusions Incidental durotomy during first-time lumbar discectomy does not appear to impact long-term outcome in affected patients.

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“…2,[11][12][13] In cases of isolated dural tear without arachnoid tear, it should be repaired unless it is minimal. Although the arachnoid membrane is intact, the meningeal membrane is weak without the dural support.…”

Section: Discussionmentioning

confidence: 98%