Article Figures & Data
Figures
- Figure 1
Intraoperative image depicting a durotomy encountered during a uniportal full-endoscopic lumbar spine surgery.
- Figure 2
An endoscopic micropituitary rongeur is used to introduce a segment of collagen matrix for use as an inlay graft in the management of a durotomy encountered during a uniportal full-endoscopic lumbar spine surgery. The collagen matrix had been cut to be slightly larger than the dimensions of the dural tear.
- Figure 3
An endoscopic ball tip probe is used to manipulate the collagen matrix so that it passes through the durotomy and resides within the dura, plugging the hole.
- Figure 4
An endoscopic nerve hook is used to manipulate the collagen matrix so that it passes through the durotomy and resides within the dura, plugging the hole.
- Figure 5
Final appearance of the durotomy plugged with the collagen matrix. The endoscopic fluid pressure can be shut off, and an intraoperative Valsalva was performed to confirm that the inlay graft is well fixed.
- Figure 6
Oswestry Disability Index (ODI) scores for each patient before surgery and at the 6-wk postoperative follow-up appointment. Each line represents a unique patient. All patients achieved the cutoff for minimum clinically important difference.
- Figure 7
Visual analog scale (VAS) pain scores for each patient before surgery and at the 6-wk postoperative follow-up appointment. Each line represents a unique patient. The red points (all VAS scores at 0) represent an additional patient who only provided postoperative VAS pain scores. All patients reporting pre- and postoperative VAS scores achieved the cutoffs for minimum clinically important difference.
Tables
- Table 1
Patient, operative, and immediate postoperative details for the 3 patients included in the case series.
Age, y Sex ASA BMI Level Diagnosis Procedure Durotomy Location Durotomy Size, mm Repair Agent Operative Time, min Length of Hospital Stay, min 73 M 3 26.7 L2-L3 Large, central HNP causing canal and right greater than left lateral recess stenosis with right L3 radiculopathy Right transforaminal discectomy Ventral nerve root sleeve of the traversing right L3 nerve root 2 Collagen matrix 87 309 49 M 1 28.1 L3-L4 Left-sided foraminal/far lateral HNP causing left L3 radiculopathy Left transforaminal discectomy Ventrolateral aspect of the traversing left L4 root 2 Collagen matrix 58 172 43 F 1 24.1 L4-L5 Facet and ligamentum flavum hypertrophy with superimposed left paracentral HNP causing lateral recess stenosis and left L5 radiculopathy Left interlaminar hemilaminotomy and discectomy Dorsolateral aspect of the thecal sac 2.5 Collagen matrix and polyethylene glycol hydrogel 123 1068 Abbreviations: ASA, American Society of Anesthesiologists; BMI, body mass index; F, female; HNP, herniated nucleus pulposus; M, male.
Variable n Median Range ODI Preoperative 3 42 20–62 Postoperative 3 0 0–26 VAS leg Preoperative 2 7 7–7 Postoperative 3 1 0–2 VAS low back Preoperative 2 6 5–7 Postoperative 3 0 0–5 Abbreviations: ODI, Oswestry Disability Index; VAS, visual analog scale.
Note: All patients with pre- and postoperative scores achieved the cut-off for minimum clinically important differences in ODI and VAS.
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