Authors
Alexanyan M.M., Gemdzhian E.G., Aganesov A.G.
B.V. Petrovsky Russian Research Center of Surgery, Moscow
Abstract
Background. Incidental durotomy is a common complication in degenerative spine surgery and according to the literature occurs in 1 to 17%. Different clinical cases with severe complications are described and which are resulted in wrong tactics for dural lesion treatment.
Objective. To evaluate frequency, treatment methods and possible complications of incidental durotomy in spinal degenerative disease surgery.
Material and Methods. A retrospective analysis of the data of 859 patients who underwent surgery in spinal department since 2018 till 2021.
Results. 22 cases of incidental durotomies were found. One during anterior cervical discectomy (ACD), one during lumbar laminectomy with posterior instrumentation, six during microdiscectomy and fourteen during lumbar minimally invasive unilateral decompression. Three patients repeated revision surgery due to complication: liquorrhea, wound infection. Maximum follow-up period was 24 months. Positive results were achieved in all cases. The frequency of incidental durotomies depends on whether the operation is revision: 18.8% (9 injuries out of 48 revision operations) vs. 1.6% (13 injuries out of 811 primary operations). p<0.001. The risk of durotomy during revision surgery is 10 times higher (RR = 10,0; 95%, CI: 4,5–22,4).
Conclusion. A statistically significant relationship was revealed between the incidence of durotomy and the type of surgery. During minimally invasive unilateral decompression for bilateral stenosis the risk of incidental durotomy is significantly higher. Primary repair of the incidental durotomy is recommended to prevent complications. If wound liquorrhea is detected, lumbar drainage system is recommended. The liquorrhea lasting more than 48 hours is an indication for revision surgery. In our study the VAS back and limb score and ODI did not differ from similar data of patients without incidental durotomy. If primary repair of durotomy is performed and liquorrhea is eliminated, the results of treatment of this patients are good. No consequences are noted when primarily dural repair is performed.
Keywords: dural tear, durotomy, complications, spine surgery.
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