Incidental durotomy within the pediatric backbone inhabitants.
J Neurosurg Pediatr. 2018 Aug 03;:1-Four
Authors: West JL, Arnel M, Palma AE, Frino J, Powers AK, Couture DE
OBJECTIVE Backbone surgical procedure is much less frequent in kids than adults. These surgical procedures, like all others, are topic to issues reminiscent of bleeding, an infection, and CSF leak. The speed of incidental durotomy within the pediatric inhabitants, and its related issues, has scarcely been reported within the literature. METHODS It is a retrospective chart evaluate of all pediatric sufferers operated on at Wake Forest Baptist Well being from 2012 to 2017 who underwent backbone surgical procedures. The authors excluded any procedures with meant durotomy, reminiscent of tethered twine launch or spinal twine tumor resection. RESULTS From 2012 to 2017, 318 pediatric sufferers underwent surgical procedure for quite a lot of indications, together with adolescent idiopathic scoliosis (51.9%), neuromuscular scoliosis (27.Four%), thoracolumbar fracture (2.83%), and different non-fusion-related indications (three.77%). Of those sufferers, the typical age was 14.1 years, and 71.zero% have been feminine. There have been 6 complete incidental durotomies, leading to an general incidence of 1.9%. The incidence was 18.5% in revision operations, in comparison with zero.34% for index surgical procedures. Comparability of the revision cohort to the durotomy cohort revealed a pattern towards elevated size of keep, operative time, and blood loss; nevertheless, the developments weren’t statistically vital. The pedicle probe was implicated in three circumstances and the precise trigger was not ascertained within the remaining three circumstances. The three durotomies brought on by pedicle probe have been handled with bone wax; 1 was handled with dry Gelfoam utility and a pair of have been handled with major restore. Just one affected person had a persistent leak postoperatively that finally required wound revision. CONCLUSIONS Incidental durotomy is an unusual prevalence within the pediatric spinal surgical procedure inhabitants. The bulk occurred throughout placement of pedicle screws, they usually have been simply handled with bone wax on the time of surgical procedure. Consciousness of the incidence, predisposing components, and remedy choices is necessary in stopping issues and incapacity.
PMID: 30074446 [PubMed – as supplied by publisher]