Accidental Dural Tears in Minimally Invasive Spinal Surgery for Degenerative Lumbar Spine Disease

Frontiers in Surgery

article

Stefan Aspalter¹  Harald Stefanits¹  Wolfgang Senker¹  Christian Radl¹  Martin Aichholzer¹  Kathrin Aufschnaiter-Hießböck¹  Clemens Leitner¹  Nico Stroh¹  Wolfgang Trutschnig²  Andreas Gruber¹ 

[1] Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University;Department of Mathematics, University of Salzburg

关键词: spine;    spinal fusion;    spine surgery;    minimally invasive surgical procedure;    cerebrospinal fluid leak;    dural tear;   

DOI  :  10.3389/fsurg.2021.708243

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: One of the most frequent complications of spinal surgery is accidental dural tears (ADTs). Minimal access surgical techniques (MAST) have been described as a promising approach to minimizing such complications. ADTs have been studied extensively in connection with open spinal surgery, but there is less literature on minimally invasive spinal surgery (MISS). Materials and Methods: We reviewed 187 patients who had undergone degenerative lumbar spinal surgery using minimally invasive spinal fusions techniques. We analyzed the influence of age, Body Mass Index (BMI), smoking, diabetes, and previous surgery on the rate of ADTs in MISS. Results: Twenty-two patients (11.764%) suffered from an ADT. We recommended bed rest for two and a half to 5 days, depending on the type of repair required and the amount of cerebrospinal fluid (CSF) leakage. We could not find any statistically significant correlation between ADTs and age ( p = 0.34,), BMI ( p = 0.92), smoking ( p = 0.46), and diabetes ( p = 0.71). ADTs were significantly more frequent in cases of previous surgery ( p < 0.001). None of the patients developed a transcutaneous CSF leak or post-operative infection. Conclusions: The frequency of ADTs in MISS appears comparable to that encountered when using open surgical techniques. Additionally, MAST produces less dead space along the corridor to the spine. Such reduced dead space may not be enough for pseudomeningocele to occur, cerebrospinal fluid to accumulate, and fistula to form. MAST, therefore, provides a certain amount of protection.

【 授权许可】

CC BY