Incidence and Management Outcome of Incidental Durotomy in Spinal Procedures in Tertiary Care Hospital
Objective: To know the incidence and management outcome of incidental durotomy in spinal procedures in tertiary care hospital.
Materials and Methods: This descriptive study was carried out in Neurosurgery Department, Hayatabad Medical Complex, Peshawar, from 1st July 2015 to 30 June 2017. All those patients in whom lumber spinal procedures were done were included in the study without age or gender discrimination. Exclusion criteria included patients in whom dura was intentionally opened as in cases of intradural tumors or in rare cases of transdural discectomies. Those patients were also excluded in whom procedure was done elsewhere and they were admitted in ward for management. All patients were reviewed by age, sex, indications of surgery and subsequent management of durotomy. Data was analyzed in SPSS version 10.
Results: Total 560 patients qualified the selection criteria. There were 342 (61.07) male and 318 (38.93%) female patients. Amongst those operated, 294 (52.5%) patients had lumbar disc herniations, 143 (25.54%) patients were operated for lumbar spinal stenosis, 75 (13.39%) patients were treated for traumatic lumbar vertebral fractures, 38 (6.79%) patients had extradural spinal tumors and 10 were operated for lumbar spondylolisthesis. We noticed incidental durotomies in 50 (8.92%) cases. Of 342 male patients the incidence of durotomy was 20 (3.57%) while of 318 female patients the incidence was 30 (5.36%). All dural tears were recognized during the operation. Forty seven (47) dural tears were repaired primarily. We did re exploration in one patient for persistent leak in whom dural stitches were torn. Kerrisonrongeur was responsible for dural tear in 14. In 11 cases dissector tear the dura. Three dural tears were caused by pituatery rongeur. One tear was caused directly by knife. Air drill was responsible for 4 tears when lamina was being drilled to thin out. We could not find any cause of dural tear in one case.
Conclusion: Unintentional duratomy is not an uncommon complication in neuro spinal procedures. This is more common female population and elderly patients with degenerative spinal diseases.
2. Hodges SD, Humphreys SC, Eck JC, Covington LA. Management of incidental duratomy without mandatory bed rest. A retrospective review of 20 cases. Spine (Phila Pa 1976), 1999; 24: 2062-2064.
3. Takahashi Y, Sato T, Hyodo H, Kawamata T, Takahashi E, Miyatake N, Tokunaga M.Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations. J Neurosurg spine, 2013; 18: 165-169.
4. Guerin P, Benchikh A, Fegoun El, et al. Incidental duratomy during spine surgery: Incidence, management and complications. Journal.
5. Deyo RA , Cherkin DC, Loeser JD, et al. Morbidity and mortality in association with operations on lumbar spine. J Bone Joint Surg. 1992; 74A: 536-43.
6. Eismont FJ, Wiesel SW, Rothman RH. Treatment of dural tears associated with spinal surgery. J Bone and Joint Surg [Am], 1981; 63: 1132-6.
7. Cammisa FP Jr, Giradi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS: Incidental duratomy in spine surgery. Spine, 2000; 25: 2663-2667.
8. Saxler G, Kramer J, Barden B, Kurt A, Pfortner J, Bernsmann K: The long-term clinical sequelae of incidental duratomy in lumbar disc surgery. Spine, 2005; 30: 2298-2302.
9. Barrios C, Ahmed M, Arrotegui JI, et al. Clinical factors predicting outcome after surgery for herniated lumbar disc:an epidemiological multivariate analysis.J Spinal Disord. 1990; 3: 205-9.
10. Tafazal SI, Sell PJ: Incidental duratomy in lumbar spine surgery: Incidence and management. Eur Spine J. 2005; 14: 287-290.
11. Epstein NE: The frequency and etiology of intra-operative dural tears in 110 predominantly geriatric patients undergoing multilevel laminectomy with non-instrumental fusions. J Spinal Disord Tech. 2007; 20: 380- 386.
12. Wang JC, Bohlman HH, Riew KD: Dural tears secondary to operations on lumbar spine. Management and results after a two years minimum follow-up of 88 patients. J Bone and Joint Surg Am. 1998; 80: 1728-1732.
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