Incidental Dural Tears in Lumbar Decompressive Surgery: Incidence, Causes, Treatment, Results: Incidental Dural Tears in Lumbar Decompressive Surgery

Neem Ul     Haq; Inayat Shah; Musawer Khan

doi:10.54393/pbmj.v5i6.510

Authors

Neem Ul Haq Neurosurgery Unit, MMC Bacha Khan Medical Collage Mardan KPK Pakistan
Inayat Shah Neurosurgery Unit, MTI Mardan Medical Complex KPK Pakistan
Musawer Khan Department Of Neurosurgery, Mardan Medical Complex KPK Pakistan

DOI:

https://doi.org/10.54393/pbmj.v5i6.510

Keywords:

Spinal Surgery, Dural Tear, Cerebrospinal Fluid Seepage, Durotomy, Herniation

Abstract

Durotomy (Incidental dural tears or ID) is a very rarely occurring disorder when decompressive surgery (spinal surgery) of the patients takes place. This disorder has severe effects on patients. During different surgeries of the spinal cord, the chances of this durotomy vary greatly. Objective: The main objective of this research work is to evaluate the main reasons for the incidence of this durotomy disease. During different surgeries of the spinal cord surgeries (decompressive and compressive) within the different regions, many factors play their role in the initiation of this durotomy disease. It is the target of this work to find the initiation factors of the disease so that effective methods of treatment can also find out. Methods: It was a retrospective study with a statistical approach. This study was conducted in Neurosurgery unit, Mardan medical complex / Bacha khan medical college, Mardan for the Duration of one year August 2020 to July 2021. To proceed with this study, 30 patients were selected with posterolateral and posterior compressive and decompressive surgeries within the different regions of the spinal cord. The patients were randomly selected from December 2020 to December 2021. Results: The incidence of this durotomy disease was investigated within all groups and the probability of this disease was only 12.65%. The occurrence of this disease also depends upon the type of surgery. Patients suffering from spinal trauma, stenosis of the spinal, different tumors, and vertebral disc herniation had exaggerating role in the incidence of durotomy in patients having some spinal surgery. Conclusion: The durotomy disease should be considered a serious issue with a number of other complications. For the treatment of this disease, prevention is the best method and to know about the complications is important because all of the factors involved in the incidence of durotomy should be considered while performing any kind of surgery

References

Strömqvist F, Sigmundsson FG, Strömqvist B, Jönsson B, Karlsson MK. Incidental durotomy in degenerative lumbar spine surgery - a register study of 64,431 operations. Spine J. 2019 Apr;19(4):624-630. doi: 10.1016/j.spinee.2018.08.012.

Ishikura H, Ogihara S, Oka H, Maruyama T, Inanami H, Miyoshi K et al. Risk factors for incidental durotomy during posterior open spine surgery for degenerative diseases in adults: A multicenter observational study. PLoS One. 2017 Nov 30;12(11):e0188038. doi: 10.1371/journal.pone.0188038.

Longo UG, Loppini M, Romeo G, Maffulli N, Denaro V. Errors of level in spinal surgery: an evidence-based systematic review. J Bone Joint Surg Br. 2012 Nov;94(11):1546-50. doi: 10.1302/0301-620X.94B11.29553.

Choi G, Pophale CS, Patel B, Uniyal P. Endoscopic Spine Surgery. J Korean Neurosurg Soc. 2017 Sep;60(5):485-497. doi: 10.3340/jkns.2017.0203.004.

Haddad S, Millhouse PW, Maltenfort M, Restrepo C, Kepler CK, Vaccaro AR. Diagnosis and neurologic status as predictors of surgical site infection in primary cervical spinal surgery. Spine J. 2016 May;16(5):632-42. doi: 10.1016/j.spinee.2016.01.019.

Kamenova M, Leu S, Mariani L, Schaeren S, Soleman J. Management of Incidental Dural Tear During Lumbar Spine Surgery. To Suture or Not to Suture? World Neurosurg. 2016 Mar;87:455-62. doi: 10.1016/j.wneu.2015.11.045.

Guler UO, Yuksel S, Yakici S, Domingo-Sabat M, Pellise F, Pérez-Grueso FJ et al. Analysis of the reliability of surgeons' ability to differentiate between idiopathic and degenerative spinal deformity in adults radiologically. What descriptive parameters help them decide? Eur Spine J. 2016 Aug;25(8):2401-7. doi: 10.1007/s00586-015-4366-3.

Carl B, Bopp M, Saß B, Nimsky C. Microscope-Based Augmented Reality in Degenerative Spine Surgery: Initial Experience. World Neurosurg. 2019 Aug;128:e541-e551. doi: 10.1016/j.wneu.2019.04.192.

Strömqvist F, Sigmundsson FG, Strömqvist B, Jönsson B, Karlsson MK. Incidental durotomy in degenerative lumbar spine surgery - a register study of 64,431 operations. Spine J. 2019 Apr;19(4):624-630. doi: 10.1016/j.spinee.2018.08.012.

Adogwa O, Huang MI, Thompson PM, Darlington T, Cheng JS, Gokaslan ZL et al. No difference in postoperative complications, pain, and functional outcomes up to 2 years after incidental durotomy in lumbar spinal fusion: a prospective, multi-institutional, propensity-matched analysis of 1,741 patients. The Spine Journal. 2014 Sep 1;14(9):1828-34. doi.org/10.1016/j.spinee.2013.10.023.

Ulrich NH, Burgstaller JM, Brunner F, Porchet F, Farshad M, Pichierri G et al. The impact of incidental durotomy on the outcome of decompression surgery in degenerative lumbar spinal canal stenosis: analysis of the Lumbar Spinal Outcome Study (LSOS) data--a Swiss prospective multi-center cohort study. BMC Musculoskelet Disord. 2016 Apr 18;17:170. doi: 10.1186/s12891-016-1022-y.

Du JY, Aichmair A, Kueper J, Lam C, Nguyen JT, Cammisa FP et al. Incidental durotomy during spinal surgery: a multivariate analysis for risk factors. Spine (Phila Pa 1976). 2014 Oct 15;39(22):E1339-45. doi: 10.1097/BRS.0000000000000559.

Desai A, Ball PA, Bekelis K, Lurie JD, Mirza SK, Tosteson TD et al. Outcomes after incidental durotomy during first-time lumbar discectomy. J Neurosurg Spine. 2011 May;14(5):647-53. doi: 10.3171/2011.1.SPINE10426.

Gautschi OP, Stienen MN, Smoll NR, Corniola MV, Tessitore E, Schaller K. Incidental durotomy in lumbar spine surgery--a three-nation survey to evaluate its management. Acta Neurochir (Wien). 2014 Sep;156(9):1813-20. doi: 10.1007/s00701-014-2177-7.

Herren C, Sobottke R, Mannion AF, Zweig T, Munting E, Otten P et al. Incidental durotomy in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcomes in the Spine Tango registry. Eur Spine J. 2017 Oct;26(10):2483-2495. doi: 10.1007/s00586-017-5197-1.

Hershman S, Cuellar VG, Bendo JA. Delayed presentation of incidental durotomy. Bull Hosp Jt Dis (2013). 2013 Jul;71(3):231-4.

Bosacco SJ, Gardner MJ, Guille JT. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res. 2001 Aug;(389):238-47. doi: 10.1097/00003086-200108000-00033.

Cain JE Jr, Lauerman WC, Rosenthal HG, Broom MJ, Jacobs RR. The histomorphologic sequence of dural repair. Observations in the canine model. Spine (Phila Pa 1976). 1991 Aug;16(8 Suppl):S319-23.

Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental durotomy in spine surgery. Spine (Phila Pa 1976). 2000 Oct 15;25(20):2663-7. doi: 10.1097/00007632-200010150-00019.

Eismont FJ, Wiesel SW, Rothman RH. Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am. 1981 Sep;63(7):1132-6.

Goodkin R, Laska LL. Unintended “incidental” durotomy during surgery of the lumbar spine: medicolegal implications. Surgical neurology. 1995 Jan 1;43(1):4-14. doi.org/10.1016/0090-3019(95)80031-B.

Wang JC, Bohlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am. 1998 Dec;80(12):1728-32. doi: 10.2106/00004623-199812000-00002