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Full endoscopic treatment of dural tears in lumbar spine surgery

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Abstract

Purpose

An incidental durotomy is a common complication of spinal surgery. Its treatment remains challenging, especially in endoscopic procedures. The objective of this study is to describe a technique for endoscopic dural closure which is safe and effective.

Methods

From a prospective database all endoscopic spinal procedures with incidental durotomy were identified. Retrospectively, video recordings were analysed with a special reference to the applied technique of dural closure. Additionally 1, 6 and 12 week follow-up examinations were evaluated for clinical outcome and associated complications.

Results

Out of 212 consecutive patients, an intraoperative dural tear was observed in nine patients (4.2%). A dural tear occurred in 1.1% of cases of lumbar disc herniation, in 7.9% of cases with lumbar spinal stenosis, in 37.5% of cases with a synovial cyst. An autologous muscle sample was harvested within the operative field and grafted at the dural defect in several layers. Fixation of the transplantation and watertight closure were achieved by the application of fibrin sealant with gelfoam. The mean time for dural closure was 209 s (range 47–420 s). Postoperatively no CSF fistula, no new deficits nor worsening of a pre-existing neurological deficit occurred. None of the patients had problems with wound healing, or discomfort which could be related to the CSF leak.

Conclusions

Dural closure with an autologous muscle graft in combination with fibrin sealant patch is a fast, safe and alternative technique for the management of dural tear in microendoscopic surgery.

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References

  1. He J, Xiao S, Wu Z, Yuan Z (2016) Microendoscopic discectomy versus open discectomy for lumbar disc herniation: a meta-analysis. Eur Spine J 25(5):1373–1381. doi:10.1007/s00586-016-4523-3

    Article  PubMed  Google Scholar 

  2. Stromqvist F, Jonsson B, Stromqvist B, Swedish Society of Spinal S (2010) Dural lesions in lumbar disc herniation surgery: incidence, risk factors, and outcome. Eur Spine J 19(3):439–442. doi:10.1007/s00586-009-1236-x

    Article  PubMed  Google Scholar 

  3. Guerin P, El Fegoun AB, Obeid I, Gille O, Lelong L, Luc S, Bourghli A, Cursolle JC, Pointillart V, Vital JM (2012) Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury 43(4):397–401. doi:10.1016/j.injury.2010.12.014

    Article  PubMed  Google Scholar 

  4. Tafazal SI, Sell PJ (2005) Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J 14(3):287–290. doi:10.1007/s00586-004-0821-2

    Article  PubMed  Google Scholar 

  5. Shibayama M, Mizutani J, Takahashi I, Nagao S, Ohta H, Otsuka T (2008) Patch technique for repair of a dural tear in microendoscopic spinal surgery. J Bone Jt Surg Brit 90(8):1066–1067. doi:10.1302/0301-620X.90B8.20938

    Article  CAS  Google Scholar 

  6. Chou D, Wang VY, Khan AS (2009) Primary dural repair during minimally invasive microdiscectomy using standard operating room instruments. Neurosurgery 64(5 Suppl 2):356–358. doi:10.1227/01.NEU.0000338942.11337.DA (discussion 358–359)

    PubMed  Google Scholar 

  7. Than KD, Wang AC, Etame AB, La Marca F, Park P (2008) Postoperative management of incidental durotomy in minimally invasive lumbar spinal surgery. Minim Invas Neurosurg 51(5):263–266. doi:10.1055/s-0028-1082313

    Article  CAS  Google Scholar 

  8. Ahn Y, Lee HY, Lee SH, Lee JH (2011) Dural tears in percutaneous endoscopic lumbar discectomy. Eur Spine J 20(1):58–64. doi:10.1007/s00586-010-1493-8

    Article  PubMed  Google Scholar 

  9. Wu X, Zhuang S, Mao Z, Chen H (2006) Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine 31(23):2689–2694. doi:10.1097/01.brs.0000244615.43199.07

    Article  PubMed  Google Scholar 

  10. Tsutsumimoto T, Yui M, Uehara M, Ohta H, Kosaku H, Misawa H (2014) A prospective study of the incidence and outcomes of incidental dural tears in microendoscopic lumbar decompressive surgery. Bone Jt J 96-B(5):641–645. doi:10.1302/0301-620X.96B5.32957

    Article  CAS  Google Scholar 

  11. Ruban D, O’Toole JE (2011) Management of incidental durotomy in minimally invasive spine surgery. Neurosurg Focus 31(4):E15. doi:10.3171/2011.7.FOCUS11122

    Article  PubMed  Google Scholar 

  12. Tan LA, Takagi I, Straus D, O’Toole JE (2014) Management of intended durotomy in minimally invasive intradural spine surgery: clinical article. J Neurosurg Spine 21(2):279–285. doi:10.3171/2014.3.SPINE13719

    Article  PubMed  Google Scholar 

  13. Gautschi OP, Stienen MN, Smoll NR, Corniola MV, Tessitore E, Schaller K (2014) Incidental durotomy in lumbar spine surgery—a three-nation survey to evaluate its management. Acta Neurochir (Wien) 156(9):1813–1820. doi:10.1007/s00701-014-2177-7

    Article  Google Scholar 

  14. Oertel JM, Mondorf Y, Gaab MR (2009) A new endoscopic spine system: the first results with “Easy GO”. Acta Neurochir 151(9):1027–1033. doi:10.1007/s00701-009-0454-7

    Article  PubMed  Google Scholar 

  15. Oertel JM, Philipps M, Burkhardt BW (2016) Endoscopic posterior cervical foraminotomy as a treatment for osseous foraminal stenosis. World Neurosurg 91:50–57. doi:10.1016/j.wneu.2016.02.073

    Article  PubMed  Google Scholar 

  16. Teli M, Lovi A, Brayda-Bruno M, Zagra A, Corriero A, Giudici F, Minoia L (2010) Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J 19(3):443–450. doi:10.1007/s00586-010-1290-4

    Article  PubMed  PubMed Central  Google Scholar 

  17. Quigley MR, Bost J, Maroon JC, Elrifai A, Panahandeh M (1998) Outcome after microdiscectomy: results of a prospective single institutional study. Surg Neurol 49(3):263–267 (discussion 267–268)

    Article  CAS  PubMed  Google Scholar 

  18. Daneyemez M, Sali A, Kahraman S, Beduk A, Seber N (1999) Outcome analyses in 1072 surgically treated lumbar disc herniations. Minim Invas Neurosurg 42(2):63–68. doi:10.1055/s-2008-1053372

    Article  CAS  Google Scholar 

  19. Nohara Y, Taneichi H, Ueyama K, Kawahara N, Shiba K, Tokuhashi Y, Tani T, Nakahara S, Iida T (2004) Nationwide survey on complications of spine surgery in Japan. J Orthop Sci 9(5):424–433. doi:10.1007/s00776-004-0802-7

    Article  PubMed  Google Scholar 

  20. Philipps M, Oertel J (2010) High-definition imaging in spinal neuroendoscopy. Minim Invas Neurosurg 53(3):142–146. doi:10.1055/s-0030-1262811

    Article  CAS  Google Scholar 

  21. Saxler G, Kramer J, Barden B, Kurt A, Pfortner J, Bernsmann K (2005) The long-term clinical sequelae of incidental durotomy in lumbar disc surgery. Spine 30(20):2298–2302

    Article  PubMed  Google Scholar 

  22. Khan MH, Rihn J, Steele G, Davis R, Donaldson WF 3rd, Kang JD, Lee JY (2006) Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3183 consecutive degenerative lumbar cases. Spine 31(22):2609–2613. doi:10.1097/01.brs.0000241066.55849.41

    Article  PubMed  Google Scholar 

  23. Epstein NE (2013) A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery. Surg Neurol Int 4(Suppl 5):S301–S317. doi:10.4103/2152-7806.111427

    Article  PubMed  PubMed Central  Google Scholar 

  24. Palmer S, Davison L (2012) Minimally invasive surgical treatment of lumbar spinal stenosis: two-year follow-up in 54 patients. Surg Neurol Int 3:41. doi:10.4103/2152-7806.94294

    Article  PubMed  PubMed Central  Google Scholar 

  25. Park P, Leveque JC, La Marca F, Sullivan SE (2010) Dural closure using the U-clip in minimally invasive spinal tumor resection. J Spinal Disord Tech 23(7):486–489. doi:10.1097/BSD.0b013e3181c7e901

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg, Saarland, Germany

    Joachim M. Oertel & Benedikt W. Burkhardt

  2. Klinik fuer Neurochirurgie, Universitaetsklinikum des Saarlandes, Kirrbergerstraße 100, Gebaeude 90.5, 66424, Homburg, Germany

    Joachim M. Oertel

Authors
  1. Joachim M. Oertel
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Correspondence to Joachim M. Oertel.

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Conflict of interest

J. Oertel and B. Burkhardt have no conflict of interest.

Funding

None.

Disclosure

J. Oertel is a consultant to the Karl Storz Company.

Electronic supplementary material

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Video 1: Endoscopic dural closure after synovial cyst resection (MP4 11083 kb)

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Oertel, J.M., Burkhardt, B.W. Full endoscopic treatment of dural tears in lumbar spine surgery. Eur Spine J 26, 2496–2503 (2017). https://doi.org/10.1007/s00586-017-5105-8

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  • DOI: https://doi.org/10.1007/s00586-017-5105-8

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