Anterior Lumbar Dural Tear: A Transthecal Route for Main Closure After Iatrogenic Durotomy.
World Neurosurg. 2017 Nov;107:522-525
Authors: Nakhla J, Nasser R, de la Garza Ramos R, Kobets A, Ammar A, Echt M, Gelfand Y, Kinon M, Yassari R
BACKGROUND: Durotomies are usually not rare in backbone surgical procedure and have elevated complication charges. Main restore is the gold customary and is possible when entry will not be restricted by the anatomy. A affected person who offered 1 week after spinal fusion with cerebrospinal fluid (CSF) leak underwent a novel transthecal strategy to restore an anterior dural tear.
OBJECTIVE: To display the feasibility, sturdiness, and security of a transthecal reconstruction to restore an anterior dural tear.
METHODS: A affected person with spinal stenosis at L4-L5 and a spondylolisthesis at L5-S1 underwent an L4-S1 posterior lumbar interbody fusion. The process was difficult by a CSF leak throughout graft placement of the anterior dura. This location didn’t enable for a main closure, and a fats graft was positioned with fibrin glue. 9 days later, the affected person developed postural complications, and CSF was leaking from the wound. The affected person underwent an exploration, and essentially the most lateral facet of the tear was visualized when retracting medially, though not sufficient for a main restore. A posterior durotomy was made and the anterior dural tear was repaired from the within.
RESULTS: The affected person signs resolved and had radiologic enchancment of the pseudomeningocele. This represents the primary reported transthecal path to restore an anterior dural tear within the lumbar backbone. The process was technically possible, efficient, and sturdy, with the affected person having full decision of his CSF leak.
CONCLUSIONS: Dorsal transthecal entry to the ventral facet of the lumbar thecal sac for inadvertent anterior dural tears is a secure, possible, and sturdy surgical administration technique.
PMID: 28823663 [PubMed – indexed for MEDLINE]