Management of incidental durotomy in minimally invasive spine surgery

Ruban, Dmitry; O’Toole, John E.

doi:10.3171/2011.7.focus11122

Cited by 89 publications

(60 citation statements)

References 44 publications

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“…Furthermore, the pulsatile CSF pushes the fleece against the dura, increasing the sealing effect. [5,[12][13][14][15][16][17][18][19]. Primary closure with Prolene 5/0 or 7/0 is our first choice.…”

Section: Ten-step Closure Techniquementioning

confidence: 99%

Incidental durotomy in spine surgery: first aid in ten steps

2015

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Introduction Incidental durotomy (ID) is the most common complication of spine surgery. Revision procedures, ossification of the yellow ligament, or synovial cysts are well-known risk factors. The size, shape, and severity of ID are unpredictable, ranging from a pinpoint hole to a several centimeters large dural laceration with transected fibers following the slippage of a cutting burr. Furthermore, the occurrence of ID is always unexpected. Intra-operative management is often based on a steep learning curve rather than a structured scheme. Purpose To provide an intra-operative ten-step closure technique (10ST) for IDs of varying severity. Methods A database of 4020 consecutive surgeries for lumbar degenerative disease over the past 4 years was searched for ID. The records of 176 patients were analyzed. Two dural repair techniques were compared: the ''individual'' technique (InT) and the 10ST. Results The overall prevalence of ID was 4.4 %. The prevalence was lowest in virgin micro-discectomies (1.7 %) and ranged from 3.6 % in decompression for spinal canal stenosis up to 14.5 % in revision procedures. All surgeries were performed with the aid of a microscope. Among 107 primary surgeries, the InT achieved a singlestage closure of the ID in 96 procedures (89.7 %). Among 20 virgin surgeries, the 10ST was successful in all cases (P = 0.21). Among 42 re-do procedures following failed attempts to stop cerebrospinal fluid (CSF) leakage, the InT achieved single-stage closure in 36 procedures (85.7 %). The 10ST was successful in all 26 cases (P = 0.03). The follow-up was 1 year. Conclusions The 10ST should be considered for successful single-stage closure in primary repair of ID.

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Section: Ten-step Closure Techniquementioning

confidence: 99%

Incidental durotomy in spine surgery: first aid in ten steps

2015

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“…Unintended durotomy is a common complication in spine surgery that may lead to serious complications if not recognized. 40 During the study follow-up period, the patients with unintended durotomies, i.e., an unintentional opening of dura during the operation, were excluded from the study.…”

Section: Study Populationmentioning

confidence: 99%

Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial

Farrokhi¹,

Lotfi

Masoudi³

et al. 2016

SPI

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OBJECT Despite advances in surgical and anesthesiology techniques, many patients continue to experience postoperative pain after lumbar disc operations. This study aims to investigate the effects of methylene blue (MB) on preventing postoperative low-back pain (LBP) with or without radicular pain and improving the quality of life (QOL) in patients undergoing lumbar open discectomy. METHODS This is a prospective, randomized, triple-blind, placebo-controlled clinical trial, which was conducted at Shiraz University of Medical Sciences between July 2011 to January 2012. Of a total of 130 patients, 115 were eligible for participation; 56 received 1 ml of MB solution at a concentration of 0.5% (MB group) and 59 received an equivalent volume of normal saline (control group). Primary outcomes were the control of LBP with or without radicular pain, which was evaluated preoperatively and at 24 hours and 3 months after surgery with the use of a visual analog scale (VAS), and the improvement of QOL, which was assessed preoperatively and 3 months postoperatively by means of the Persian translation of the Oswestry Disability Index questionnaire. RESULTS The mean VAS scores for LBP were significantly lower in the MB group compared with the control group at 24 hours (1.25 ± 0.97 vs 2.80 ± 0.69, p < 0.001) and 3 months (1.02 ± 1.29 vs 2.07 ± 1.10, p = 0.019) after treatment. The mean radicular pain scores decreased significantly in the 2 groups at 24 hours after surgery, but the mean radicular pain score was significantly lower in the MB-treated patients than the control group. However, the difference between radicular pain scores in the MB group (1 ± 1.1) and the control group (1.2 ± 1) was not statistically significant (p = 0.64). The reduction in LBP was greater in the MB group than the control group (8.11 ± 1.74 vs 6.07 ± 1.52, p = 0.023, CI 95% −1.37 to −0.10). The functional QOL improved significantly 3 months after the operation in both groups (p < 0.001). Moderate disability occurred more frequently in the control group than in the MB group (14.5% vs 7.7%, p = 0.004). No toxicity, adverse effects, or complications were found in the group of patients treated with MB injection. CONCLUSIONS A single dose of MB (1 ml 0.5%) for coating the dura and surrounding tissues (facet and muscle) shows promising results in terms of safety, reduction of postoperative pain, and functional outcome compared with placebo.

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“…The reported incidence of DT for all spine surgeries is 1.6-10 % [1][2][3][4][5][6]. Previous studies have examined various risk factors for DT, which include age, patient gender, and experience level of the surgeon [1,2,[7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Incidental dural tear in spine surgery: analysis of a nationwide database

Yoshihara

Yoneoka

2013

Eur Spine J

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Purpose The purpose of this study was to report the incidence of dural tear (DT) in spine surgery, risk factors, and patient outcomes on a national level. Methods Clinical data were obtained from the Nationwide Inpatient Sample for 2009. Patients who underwent spine surgery were identified and, among them, patients who had DT were identified, according to the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes. Patient and hospital demographic data were retrieved. The incidence of DT and inhospital patient outcomes were analyzed. Multivariate logistic regression analysis was performed to identify the risk factors for DT. Results The incidence of DT was 2.7 % (17,932/ 665,818). Multivariate analysis revealed that older age, female gender, increased Elixhauser comorbidity score, and high hospital caseload were the significant risk factors for DT. Comparison between patients with and without DT showed that those with DT had significantly higher overall in-hospital complications (18.8 vs. 10.2 %), higher inhospital mortality rate (0.4 vs. 0.3 %), longer hospital stays (5.1 vs. 3.7 days), lower proportion discharged home routinely (61.0 vs. 76.8 %), and increased total hospital charges ($85,138 vs. $71,808), respectively. Conclusions The reported incidence of DT in spine surgery was 2.7 % in the US. Risk factors included older age, female gender, increased comorbidities, and high hospital caseload. DT increased the rate of in-hospital complications and mortality and health care burdens.

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Management of incidental durotomy in minimally invasive spine surgery

Cited by 89 publications

References 44 publications

Incidental durotomy in spine surgery: first aid in ten steps

Incidental durotomy in spine surgery: first aid in ten steps

Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial

Incidental dural tear in spine surgery: analysis of a nationwide database

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