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http://dx.doi.org/10.3340/jkns.2015.58.1.60

The Incidence and Management of Dural Tears and Cerebrospinal Fluid Leakage during Corrective Osteotomy for Ankylosing Spondylitis with Kyphotic Deformity  

Jo, Dae-Jean (Department of Neurosurgery, Spine Center, Kyung Hee University Hospital at Gangdong)
Kim, Ki-Tack (Department of Orthopedic Surgery, Spine Center, Kyung Hee University Hospital at Gangdong)
Lee, Sang-Hun (Department of Orthopedic Surgery, Spine Center, Kyung Hee University Hospital at Gangdong)
Cho, Myung-Guk (Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine)
Seo, Eun-Min (Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.58, no.1, 2015 , pp. 60-64 More about this Journal
Abstract
Objective : To present the incidence and management of dural tears and cerebrospinal fluid leakage during corrective osteotomy [Pedicle Subtraction Osteotomy (PSO) or Smith-Petersen Osteotomy (SPO)] for ankylosing spondylitis with kyphotic deformity. Methods : A retrospective study was performed for ankylosing spondylitis patients with fixed sagittal imbalance, who had undergone corrective osteotomy (PSO or SPO) at lumbar level. 87 patients were included in this study. 55 patients underwent PSO, 32 patients underwent SPO. The mean age of the patients at the time of surgery was 41.7 years (21-70 years). Of the 87 patients, 15 patients had intraoperative dural tears. Results : The overall incidence of dural tears was 17.2%. The incidence of dural tears during PSO was 20.0%, SPO was 12.5%. There was significant difference in the incidence of dural tears based on surgical procedures ( PSO vs. SPO) (p<0.05). The dural tears ranged in size from 12 to $221mm^2$. A nine of 15 patients had the relatively small dural tears, underwent direct repair via watertight closure. The remaining 6 patients had the large dural tears, consequently direct repair was impossible. The large dural tears were repaired with an on-lay graft of muscle, fascia or fat harvested from the adjacent operation site. All patients had a successful repair with no patient requiring reoperation for the cerebrospinal fluid leak. Conclusion : The overall incidence of dural tears during PSO or SPO for ankylosing spondylitis with kyphotic deformity was 17.2%. The risk factor of dural tears was complexity of surgery. All dural tears were repaired primarily using direct suture, muscle, fascia or fat graft.
Keywords
Dural tears; Ankylosing spondylitis; Corrective osteotomy;
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Times Cited By KSCI : 3  (Citation Analysis)
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1 Black P : Cerebrospinal fluid leaks following spinal or posterior fossa surgery : use of fat grafts for prevention and repair. Neurosurg Focus 9 : e4, 2000
2 Blecher R, Anekstein Y, Mirovsky Y : Incidental dural tears during lumbar spine surgery : a retrospective case study of 84 degenerative lumbar spine patients. Asian Spine J 8 : 639-645, 2014   DOI
3 Bosacco SJ, Gardner MJ, Guille JT : Evaluation and treatment of dural tears in lumbar spine surgery : a review. Clin Orthop Relat Res (389) : 238-247, 2001
4 Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, et al. : Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41 : 58-67, 1998   DOI
5 Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS : Incidental durotomy in spine surgery. Spine (Phila Pa 1976) 25 : 2663-2667, 2000   DOI
6 Carette S, Graham D, Little H, Rubenstein J, Rosen P : The natural disease course of ankylosing spondylitis. Arthritis Rheum 26 : 186-190, 1983   DOI
7 Dalgic A, Okay HO, Gezici AR, Daglioglu E, Akdag R, Ergungor MF : An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula : closed lumbar drainage system. Minim Invasive Neurosurg 51 : 154-157, 2008   DOI
8 Du JY, Aichmair A, Kueper J, Lam C, Nguyen JT, Cammisa FP, et al. : Incidental durotomy during spinal surgery : a multivariate analysis for risk factors. Spine (Phila Pa 1976) 39 : E1339-E1345, 2014   DOI
9 Eismont FJ, Wiesel SW, Rothman RH : Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am 63 : 1132-1136, 1981   DOI
10 Espiritu MT, Rhyne A, Darden BV 2nd : Dural tears in spine surgery. J Am Acad Orthop Surg 18 : 537-545, 2010   DOI
11 Gautschi OP, Stienen MN, Smoll NR, Corniola MV, Schaller K : Incidental durotomy in lumbar spine surgery - is there still a role for flat bed rest? Spine J 14 : 2522-2523, 2014   DOI
12 Geusens P, Vosse D, van der Linden S : Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 19 : 335-339, 2007   DOI
13 Hida K, Yamaguchi S, Seki T, Yano S, Akino M, Terasaka S, et al. : Nonsuture dural repair using polyglycolic acid mesh and fibrin glue : clinical application to spinal surgery. Surg Neurol 65 : 136-142; discussion 142-143, 2006   DOI
14 Hodges SD, Humphreys SC, Eck JC, Covington LA : Management of incidental durotomy without mandatory bed rest. A retrospective review of 20 cases. Spine (Phila Pa 1976) 24 : 2062-2064, 1999   DOI
15 Narotam PK, José S, Nathoo N, Taylon C, Vora Y : Collagen matrix (DuraGen) in dural repair : analysis of a new modified technique. Spine (Phila Pa 1976) 29 : 2861-2867; discussion 2868-2869, 2004   DOI
16 Jones AA, Stambough JL, Balderston RA, Rothman RH, Booth RE Jr : Long-term results of lumbar spine surgery complicated by unintended incidental durotomy. Spine (Phila Pa 1976) 14 : 443-446, 1989   DOI
17 Jung YY, Ju CI, Kim SW : Bilateral subdural hematoma due to an unnoticed dural tear during spine surgery. J Korean Neurosurg Soc 47 : 316-318, 2010   DOI
18 Kitchel SH, Eismont FJ, Green BA : Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg Am 71 : 984-987, 1989   DOI
19 Park JS, Kong DS, Lee JA, Park K : Intraoperative management to prevent cerebrospinal fluid leakage after microvascular decompression : dural closure with a "plugging muscle" method. Neurosurg Rev 30 : 139-142; discussion 142, 2007   DOI
20 Stendel R, Danne M, Fiss I, Klein I, Schilling A, Hammersen S, et al. : Efficacy and safety of a collagen matrix for cranial and spinal dural reconstruction using different fixation techniques. J Neurosurg 109 : 215-221, 2008   DOI
21 Stolke D, Sollmann WP, Seifert V : Intra- and postoperative complications in lumbar disc surgery. Spine (Phila Pa 1976) 14 : 56-59, 1989   DOI
22 Tafazal SI, Sell PJ : Incidental durotomy in lumbar spine surgery : incidence and management. Eur Spine J 14 : 287-290, 2005   DOI
23 Takahashi Y, Sato T, Hyodo H, Kawamata T, Takahashi E, Miyatake N, et al. : Incidental durotomy during lumbar spine surgery : risk factors and anatomic locations : clinical article. J Neurosurg Spine 18 : 165-169, 2013   DOI
24 Wang JC, Bohlman HH, Riew KD : Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80 : 1728-1732, 1998   DOI
25 Choi JH, Kim JS, Jang JS, Lee DY : Transdural nerve rootlet entrapment in the intervertebral disc space through minimal dural tear : report of 4 cases. J Korean Neurosurg Soc 53 : 52-56, 2013   DOI
26 Hawk MW, Kim KD : Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus 9 : e5, 2000
27 Khan MH, Rihn J, Steele G, Davis R, Donaldson WF 3rd, Kang JD, et al. : Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery : a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976) 31 : 2609-2613, 2006   DOI