Incidental durotomy during spine surgery: Incidence, management and complications. A retrospective review

Guérin, Patrick M.; Fegoun, Abdelkrim Benchikh El; Obeid, Ibrahim; Gille, Olivier; Lelong, Luc; Luc, Stéphane; Bourghli, Anouar; Cursolle, Jean Christophe; Pointillart, Vincent; Vital, Jean-Marc

doi:10.1016/j.injury.2010.12.014

Cited by 229 publications

(203 citation statements)

References 31 publications

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“…Additionally, neurovascular or adjacent organ injuries have been reported (17,20,27,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Implant related complications have also been reported in the literature (20,27,(40)(41)(42)(43)(44).…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

116

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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Section: Introductionmentioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

116

113

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“…Non operative treatment of durotomies has been unsuccessful and must be treated preioperatively. 8,10 In our study, all 38 cases with DT were detected intra-operatively by the presence of CSF in the surgical field. Gerardi et al, 7 reported a 6.8% incidence of unrecognized dural tears.…”

Section: Discussionmentioning

confidence: 51%

“…Guerin et al, 8 stated that ideally primary repair of dural tears should be done and is successful in most cases. In our study, all DT were sutured primarily followed by insertion of either intrathecal drain or fat graft followed by watertight fascial closure and bed rest and this protocol of management agreed with different studies.…”

Section: Discussionmentioning

confidence: 99%

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Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts

Soliman¹

2015

Egyptian Spine Journal

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Background: Although dural tears (DTs) are known potential intraoperative complications of spine surgery, there is a relative lack of information about the true incidence of this common occurrence. Various studies have reported incidences ranging from 1.6%-17.4%. The literature on iatrogenic DT during spine surgery is surprisingly sparse; and the management is controversial. Purpose: To evaluate the use of lumbar drain and fat graft following incidental durotomy in prevention of early CSF leak and pseudomeningocele formation later on. Study Design: Prospective clinical case study. Patients and Methods: 343 patients were included in this study with degenerative spinal diseases indicated for decompression (lumbar disc, canal stenosis, degenerative spondylolisthesis or revision surgery). We excluded trauma cases and ventral tears not repaired. Patients with incidental dural tear had direct primary closure and then patients were divided into two groups: group A; a lumbar drains were inserted, and group B; a fat graft was used without drain. Both groups were followed-up for CSF leak control and pseudomeningocele formation. Results: We had 38 patients with DTs from 343 patients undergoing lumbar surgery with incidence of (11%). High incidence of DT occurred in revision surgeries (21.8%). In group (A), 85% of cases were free, 15% showed transient CSF leak managed conservatively, while in group (B), 72.2% were free, 27.7% showed transient CSF leak and 16.6% required repair for pseudomeningocele later on. Conclusion: Incidental durotomy is a well-known complication of spine surgery, and it occurs even among experienced spine surgeons. The use of lumbar drain was more efficient than fat graft in minimizing the postoperative CSF leak and pseudomeningocele formation. (2015ESJ078)

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“…In assessing 802 incidental durotomies during short-segment lumbar fusions, Stewart et al found an average of a 1.4-day increase in hospital stay resulting in an additional $10,885 in total hospital charges [13]. Another study found that 19 % (9/48) of durotomies ultimately led to a revision surgery [14].…”

Section: Analyzing Complicationsmentioning

confidence: 99%

Complications of surgical intervention in adult lumbar scoliosis

Christiansen

LaBagnara

Sure

et al. 2016

Curr Rev Musculoskelet Med

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If nonoperative measures are unsuccessful in managing the pain and disability of adult spinal deformities, surgical correction may provide the potential for significant improvement in a patient's quality of life. However, these procedures have a relatively high risk of complications. Identifying patients that may benefit from surgical intervention requires a thorough understanding of potential complications and managing the risks of any individual patient. Complications do not necessarily result in poor outcomes, and good outcomes are not always complication free. Higher risk patients potentially have more to gain, even if they experience complications. With the rapidly expanding senior population and expanded capabilities to manage high-risk patients, it is helpful to consider the lessons provided by ever expanding databases of outcome measures to refine the surgical decision-making process.

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Incidental durotomy during spine surgery: Incidence, management and complications. A retrospective review

Cited by 229 publications

References 31 publications

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts

Complications of surgical intervention in adult lumbar scoliosis

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