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Research ArticleMinimally Invasive Surgery

Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management

Kai-Uwe Lewandrowski, Stefan Hellinger, Paulo Sérgio Teixeira De Carvalho, Max Rogério Freitas Ramos, José-Antonio Soriano-SáNchez, Zhang Xifeng, André Luiz Calderaro, Thiago Soares Dos Santos, Jorge Felipe Ramírez León, Marlon Sudário de Lima e SilvA, Álvaro Dowling, Girish DataR, Jin-Sung Kim and Anthony Yeung
International Journal of Spine Surgery April 2021, 15 (2) 280-294; DOI: https://doi.org/10.14444/8038
Kai-Uwe Lewandrowski
1Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, Arizona
2Department of Neurosurgery, UNIRIO, Rio de Janeiro, Brazil
MD
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Stefan Hellinger
3Orthopaedic Surgeon, München, Germany
MD
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Paulo Sérgio Teixeira De Carvalho
4Department of Neurosurgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
MD
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Max Rogério Freitas Ramos
5Orthopedics and Traumatology, Federal University of the Rio de Janeiro State UNIRIO, Brazil
6Orthopedic Clinics, Gaffrée Guinle University Hospital, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
MD, PHD
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José-Antonio Soriano-SáNchez
7Spine Clinic, Neurological Center, ABC Medical Center, Mexico City, Mexico
MD
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Zhang Xifeng
8The Chinese PLA General Hospital, Beijing, China
MD, PHD
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André Luiz Calderaro
9Centro Ortopedico Valqueire, Departamento de Full Endoscopia da Coluna Vertebral, Rio de Janeiro, Brazil
MD
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Thiago Soares Dos Santos
10Regina Hospital, Novo Hamburgo, Rio Grande Sur, Brazil
MD
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Jorge Felipe Ramírez León
11Reina Sofía Clinic and Center of Minimally Invasive Spine Surgery, Bogotá, Colombia
12Spine Surgery Program, Universidad Sanitas, Bogotá, Colombia
MD
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Marlon Sudário de Lima e SilvA
13CLINCOL (Endoscopic Spine Clinic), Belo Horizonte, Minas Gerais, Brazil
MD
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Álvaro Dowling
14Endoscopic Spine Clinic, Santiago, Chile
15Department of Orthopaedic Surgery, USP, Ribeirão Preto, Brazil
MD
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Girish DataR
16Center for Endoscopic Spine Surgery, Sushruta Hospital for Orthopaedics and Traumatology, Miraj, Sangli, Maharashtra, India
MD
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Jin-Sung Kim
17Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Republic of Korea
MD, PHD
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Anthony Yeung
18University of New Mexico School of Medicine, Albuquerque, New Mexico
19Desert Institute for Spine Care, Phoenix, AZ
MD
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    Figure 1

    Shown is an exemplary case of (a) an incidental durotomy that the surgeon encountered in the posterior dural during interlaminar endoscopy (b) for a herniated disc at L5/S1 (c, d) with the application of a hooded power burr.

  • Figure 2
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    Figure 2

    An exemplary case of an incidental durotomy is shown. (a) The tear was in the anterior dural sac during transforaminal endoscopy (b) for foraminal and lateral recess stenosis at L3-L4 with the application of a trephine. (c) A transected rootlet was removed from the decompression site. (d) The dural defect was created in the traversing nerve root.

  • Figure 3
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    Figure 3

    An exemplary case of an incidental durotomy is shown. (a) The tear caused a rootlet herniation and had occurred with (b) the use of the Kerrison rongeur during foraminoplasty by inadvertently “biting” the traversing nerve root. (c) It measured approximately 10 mm in length, and (d) the herniated rootlets were reduced before placing a Gelfoam patch.

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International Journal of Spine Surgery
Vol. 15, Issue 2
1 Apr 2021
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Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management
Kai-Uwe Lewandrowski, Stefan Hellinger, Paulo Sérgio Teixeira De Carvalho, Max Rogério Freitas Ramos, José-Antonio Soriano-SáNchez, Zhang Xifeng, André Luiz Calderaro, Thiago Soares Dos Santos, Jorge Felipe Ramírez León, Marlon Sudário de Lima e SilvA, Álvaro Dowling, Girish DataR, Jin-Sung Kim, Anthony Yeung
International Journal of Spine Surgery Apr 2021, 15 (2) 280-294; DOI: 10.14444/8038

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Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management
Kai-Uwe Lewandrowski, Stefan Hellinger, Paulo Sérgio Teixeira De Carvalho, Max Rogério Freitas Ramos, José-Antonio Soriano-SáNchez, Zhang Xifeng, André Luiz Calderaro, Thiago Soares Dos Santos, Jorge Felipe Ramírez León, Marlon Sudário de Lima e SilvA, Álvaro Dowling, Girish DataR, Jin-Sung Kim, Anthony Yeung
International Journal of Spine Surgery Apr 2021, 15 (2) 280-294; DOI: 10.14444/8038
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Keywords

  • incidental durotomy
  • spinal endoscopy
  • interlaminar
  • transforaminal
  • management

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