Analysis and administration of small dural tears in main lumbar spinal decompression and discectomy surgical procedure.
J Clin Neurosci. 2018 Feb 08;:
Authors: Galarza M, Gazzeri R, Alfaro R, de la Rosa P, Arraez C, Piqueras C
Incidental dural tear is among the commonest intraoperative issues in lumbar backbone surgical procedure. But, its technical administration for the prevention of CSF leak is controversial. The strategy of managing dural tears will depend on the placement of the dural tears as effectively on the size and anatomical traits of the dural tear. We suggest an anatomical classification for small (lower than one cm) dural tears and report on the result of managing these dural tears varieties utilizing completely different approach for various sort. 62 sufferers underwent spinal dural restore after microdiscectomy or lumbar spinal decompression. Group 1 consisted of 20 sufferers, with Kind I or delicate dural tear who had tissue-glue coated collagen sponge or fibrin glue software. Group 2 comprised 21 sufferers with Kind II or average dural tear who had each tissue-glue coated collagen sponge and fibrin glue software. Group three comprised 21 sufferers with Kind III or extreme dural tear who had polypropylene suture and tissue-glue coated collagen sponge and/or fibrin glue software. Evident postoperative CSF leak was used to find out the affected person’s postoperative consequence. Postoperative CSF leak was not evident throughout a minimal 1?yr observe up in group 1. Inner CSF leak was evident in group 2 (n?=?three) and group three (n?=?three) throughout identical observe up. Three sufferers underwent re-do spinal surgical procedure for CSF leak restore. We advocate completely different administration approach relying on the kind of tear. For sort I, we advocate the usage of tissue-glue coated collagen sponge or fibrin glue software, with out dural suturing.
PMID: 29429786 [PubMed – as supplied by publisher]