The records of 553 consecutive patients with different types of posterior and posterolateral decompressive and reconstructive procedures in the lumbar region treated in our department within the period January 2005 – march 2009 were investigated retrospectively. With the present investigation we aim to evaluate the incidence of the incidental durotomies during the different types of decompressive and reconstructive surgical procedures in the lumbar region, also to point the most common reasons for the incidental dural tears (durotomies), treatment options and its influence to the early and late outcome. Cerebrospinal fluid (CSF) leakage following dural tears can pose potentially serious problems such as CSF fistula formation, pseudomeningocele, meningitis, arachnoiditis and epidural abscess. If a defect goes undetected or is not properly closed, the patient is likely to experience a postural headache with a combination of the following symptoms: nausea, vomiting, pain or tightness in the neck or back, dizziness, diplopia due to VI cranial nerve paresis, photophobia, tinnitus, etc. Even with experienced surgeons, inadvertent, pin-hole-type durotomies may go unrecognized during surgery. Unfortunately not all dural tears can be recognized and repaired adequately primarily. When dural injury occurs, in the majority of cases it is detected intraoperatively, and primary repair is mandatory with the established surgical techniques. One of the important intraoperative mechanisms other than direct laceration of the dura include excessive nerve root traction during the removal of big disc extrusions and implantation of spinal instrumentation. The number and complexity of spinal procedures is increasing in the last decades, leading to a greater prevalence of dural tears. The majority of authors relate the increased rate of dural tears with the increase of reoperation rate, respectively with epidural fibrosis, and with the advanced spinal degenerative changes with ossified yellow ligament among elderly people undergoing surgery. The incidence of incidental durotomies varies widely among authors (1-17%) and in general depends on the type and the complexity of the spinal procedures. The incidental durotomy during lumbar decompressive surgery is a relatively rare complication that could cause severe complications.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |