Unique Bone Suture Anchor Repair of Complex Lumbar Cerebrospinal Fluid Fistulas

Background: Spine surgeons encounter occasional complex cerebrospinal fluid fistulas/dural tears (CSF/DT) during lumbar spinal surgery. In some cases, these leaks are found during the index procedure, but others may appear postoperatively, or in the course of successive procedures. Here we asked, whether these complex CSF fistulas/DT could be more readily repaired utilizing a “bone suture anchor” technique, particularly where there is no residual dural margin/remnant. Methods: With the combined expertise of the orthopedist and neurosurgeon, mini/micro bone suture anchors, largely developed for hand surgery, facilitated repair of complex DT occurring during lumbar spine surgery. This technique was utilized to suture in place fascia, periosteal, or muscle grafts, and was followed by the application of microfibrillar collagen, and a fibrin sealant. Results: This mini/micro suture anchor technique has now been utilized to repair multiple significant intraoperative and/or postoperative recurrent DT, largely avoiding the need to place lumbar drains and/or lumbo- peritoneal shunts. Conclusions: Here, we reviewed how to directly suture dural grafts utilizing a mini/micro bone suture anchor technique to repair complex intraoperative primary/recurrent DT occurring during lumbar spine surgery. The major advantages of this technique, in addition to obtaining definitive occlusion of the DT, largely avoids the need to place lumbar drains and/or lumbo-peritoneal shunts with their attendant risks and complications.

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Foramen magnum syndrome after iatrogenic cerebrospinal fluid leak during lumbar spine surgery: A series of two cases

Indian Spine Journal ◽

10.4103/isj.isj_47_18 ◽

2019 ◽

Vol 2 (2) ◽

pp. 169

Author(s):

SiddharthA Badve ◽

Michael Galgano ◽

RichardA Tallarico ◽

WilliamF Lavelle

Keyword(s):

Cerebrospinal Fluid ◽

Lumbar Spine ◽

Spine Surgery ◽

Cerebrospinal Fluid Leak ◽

Foramen Magnum ◽

Lumbar Spine Surgery ◽

Fluid Leak

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Postoperative Management Protocol for Incidental Dural Tears During Degenerative Lumbar Spine Surgery

Spine ◽

10.1097/01.brs.0000241066.55849.41 ◽

2006 ◽

Vol 31 (22) ◽

pp. 2609-2613 ◽

Cited By ~ 168

Author(s):

Mustafa H. Khan ◽

Jeffery Rihn ◽

Garen Steele ◽

Rick Davis ◽

William F. Donaldson ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Postoperative Management ◽

Lumbar Spine Surgery ◽

Degenerative Lumbar Spine ◽

Management Protocol ◽

Dural Tears

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Full endoscopic treatment of dural tears in lumbar spine surgery

European Spine Journal ◽

10.1007/s00586-017-5105-8 ◽

2017 ◽

Vol 26 (10) ◽

pp. 2496-2503 ◽

Cited By ~ 13

Author(s):

Joachim M. Oertel ◽

Benedikt W. Burkhardt

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Endoscopic Treatment ◽

Lumbar Spine Surgery ◽

Dural Tears

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Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013

Global Spine Journal ◽

10.1177/2192568217694151 ◽

2017 ◽

Vol 7 (3) ◽

pp. 213-219 ◽

Cited By ~ 21

Author(s):

David N. Bernstein ◽

David Brodell ◽

Yue Li ◽

Paul T. Rubery ◽

Addisu Mesfin

Keyword(s):

United States ◽

Lumbar Spine ◽

Spine Surgery ◽

International Classification Of Diseases ◽

The United States ◽

Lumbar Spine Surgery ◽

Economic Downturn ◽

Classification Of Diseases ◽

Lumbar Spinal ◽

The Impact

Study Design: Retrospective database analysis. Objective: The impact of the 2008-2009 economic downtown on elective lumbar spine surgery is unknown. Our objective was to investigate the effect of the economic downturn on the overall trends of elective lumbar spine surgery in the United States. Methods: The Nationwide Inpatient Sample (NIS) was used in conjunction with US Census and macroeconomic data to determine historical trends. The economic downturn was defined as 2008 to 2009. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), were used in order to identify appropriate procedures. Confidence intervals were determined using subgroup analysis techniques. Results: From 2003 to 2012, there was a 19.8% and 26.1% decrease in the number of lumbar discectomies and laminectomies, respectively. Over the same time period, there was a 56.4% increase in the number of lumbar spinal fusions. The trend of elective lumbar spine surgeries per 100 000 persons in the US population remained consistent from 2008 to 2009. The number of procedures decreased by 4.5% from 2010 to 2011, 7.6% from 2011 to 2012, and 3.1% from 2012 to 2013. The R2 value between the number of surgeries and the S&P 500 Index was statistically significant ( P ≤ .05). Conclusions: The economic downturn did not affect elective lumbar fusions, which increased in total from 2003 to 2013. The relationship between the S&P 500 Index and surgical trends suggests that during recessions, individuals may utilize other means, such as insurance, to cover procedural costs and reduce out-of-pocket expenditures, accounting for no impact of the economic downturn on surgical trends. These findings can assist multiple stakeholders in better understanding the interconnectedness of macroeconomics, policy, and elective lumbar spine surgery trends.

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Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations

Journal of Neurosurgery Spine ◽

10.3171/2012.10.spine12271 ◽

2013 ◽

Vol 18 (2) ◽

pp. 165-169 ◽

Cited By ~ 59

Author(s):

Yoshimasa Takahashi ◽

Tetsuro Sato ◽

Hironori Hyodo ◽

Tomomaro Kawamata ◽

Eiji Takahashi ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Spinal Canal ◽

Degenerative Spondylolisthesis ◽

Spinal Canal Stenosis ◽

Lumbar Spine Surgery ◽

Dural Tear ◽

Canal Stenosis ◽

Lumbar Spinal ◽

Incidental Durotomy

Object Incidental durotomy (dural tear) is a common complication of lumbar spine surgery. The purpose of this study was to clarify the anatomical location of and the specific causative factors for incidental durotomy during primary lumbar spine surgery. Methods The authors retrospectively reviewed 1014 consecutive cases involving patients (412 women and 602 men; mean age 57 years; age range 11–97 years) who underwent a surgical procedure for treatment of degenerative lumbar spinal disease at their institution between 2002 and 2008. In total, 1261 disc levels were treated surgically. Disease at the treated levels included 544 disc herniations, 453 instances of spinal canal stenosis without spondylolisthesis, 188 instances of lumbar spinal canal stenosis with spondylolisthesis (degenerative spondylolisthesis), 49 instances of combined stenosis (stenosis with disc herniation), and 22 juxtafacet cysts. In 5 of the treated levels, the condition was classified as “other” disease. Treatment included fenestration with discectomy in 547 levels, fenestration alone in 626, fenestration with resection of juxtafacet cysts in 22, unilateral recapping laminoplasty in 20, posterolateral spinal fusion or posterior lumbar interbody fusion in 17, microscopic discectomy with tubular retractor in 14, and “other” in 15. Results Unintended durotomy occurred in 4% of cases and in 3.3% of disc levels. The incidence of dural tear was significantly higher in women (5.6%) than in men (3%). The incidence of dural tear was 2% in disc levels with lumbar disc herniation, 1.8% with lumbar spinal canal stenosis without spondylolisthesis, 9% with degenerative spondylolisthesis, and 18.2% with juxtafacet cysts; the incidence was significantly higher in levels with degenerative spondylolisthesis or levels with juxtafacet cysts, than in those with other diseases. Incidental durotomy occurred in 4 critical anatomical zones, namely, the caudal margin of the cranial lamina, cranial margin of the caudal lamina, herniated disc level, and medial aspect of the facet joint adjacent to the insertion of the hypertrophic ligamentum flavum. Conclusions Risk factors for unintended durotomy were female sex, older age, degenerative spondylolisthesis, and juxtafacet cysts. In this study, the authors identified 4 high-risk anatomical zones that spine surgeons should be aware of to avoid dural tears.

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Remote Hemorrhage in the Cerebellum and Temporal Lobe after Lumbar Spine Surgery

Case Reports in Orthopedics ◽

10.1155/2015/972798 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Shotaro Watanabe ◽

Seiji Ohtori ◽

Sumihisa Orita ◽

Kazuyo Yamauchi ◽

Yawara Eguchi ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Lumbar Spine ◽

Temporal Lobe ◽

Dura Mater ◽

Spine Surgery ◽

Cerebrospinal Fluid Leak ◽

Leg Pain ◽

Lumbar Spine Surgery ◽

Neurosurgical Procedures ◽

Fluid Leak

Cerebellar hemorrhage remote from the site of surgery can complicate neurosurgical procedures. However, this complication after lumbar surgery is rare. Furthermore, hemorrhage in both the cerebellum and the temporal lobe after spine surgery is rarer still. Herein we present a case of remote hemorrhage in both the cerebellum and the temporal lobe after lumbar spine surgery. A 79-year-old woman with a Schwannoma at the L4 level presented with low back and bilateral leg pain refractory to conservative management. Surgery was undertaken to remove the Schwannoma and to perform posterior fusion. During the surgery, the dura mater was removed in order to excise the Schwannoma. Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak. Five days after surgery, clouding of consciousness started gradually, and hemorrhage in the cerebellum and the temporal lobe was revealed by computed tomography. Emergent evacuation of the hemorrhage was performed and the patient recovered consciousness after the surgery. Leakage of cerebrospinal fluid may have induced this hemorrhage. While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

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Incidental Dural Tear in Lumbar Spine Surgery: A Prospective Study

International Journal of Orthopaedics Research ◽

10.33140/ijor.04.03.01 ◽

2021 ◽

Vol 4 (3) ◽

Keyword(s):

Lumbar Spine ◽

Hospital Stay ◽

Spine Surgery ◽

Length Of Hospital Stay ◽

Lumbar Spine Surgery ◽

Lumbosacral Spine ◽

Dural Tear ◽

Vas Score ◽

Significant Difference ◽

Dural Tears

Introduction: Incidental dual tear is a complication of spinal surgery characterized by an accidental nick of the spinal dural sheath during operative procedures. The worldwide incidence of dural tear according to previous literature varies widely (1- 17%) and in general depends on the type and complexity of the procedure. The present was carried to evaluate the incidence of dural tear in lumbar spine surgery, and to study clinical outcomes in terms of VAS score ODI score and length of hospital stay. Methods: This was a prospective, observational and case control study conducted on 40 patients who underwent elective Lumbosacral spine surgery. The incidence of dural tear was evaluated and the patients were divided into with dural tear and without dural tear. The clinical outcome such as visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score and length of hospital stay were evaluated. Results: The incidence of Dural tear in our study population was found to be 7.5%. The ODI score was significantly higher in dural tear as compared to without dual tear at various postoperative periods. Further, there was no significant difference in the VAS scores with and without dural tear patients. The length of hospital stay was significantly higher in patients with dural tear as compared to without dural tear (11.63±6.19 vs 3.06±1.02 days; p=0.004). Conclusion: Incidental Dural tears if detected and managed accordingly, adverse clinical and postoperative outcomes can be reduced effectively and also increases the quality of life in patients.

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