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


doi: 10.3389/fsurg.2021.708243.


eCollection 2021.

Affiliations

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Stefan Aspalter et al.


Front Surg.


.

Abstract

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.


Keywords:

cerebrospinal fluid leak; dural tear; minimally invasive surgical procedure; spinal fusion; spine; spine surgery.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures


Figure 1



Figure 1

Implantation of a TLIF cage in a minimally invasive procedure using a tubular retractor.

References

    1. Ntoukas V, Müller A. Minimally invasive approach versus traditional open approach for one level posterior lumbar interbody fusion. Minim Invasive Neurosurg. (2010) 53:21–4. 10.1055/s-0030-1247560



      DOI



      PubMed

    1. Park Y, Ha JW. Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine. (2007) 32:537–43. 10.1097/01.brs.0000256473.49791.f4



      DOI



      PubMed

    1. Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine. (2003) 28(Suppl. 15):S26–35. 10.1097/00007632-200308011-00006



      DOI



      PubMed

    1. Franke J, Manson N, Buzek D, Kosmala A, Hubbe U, Rosenberg W, et al. . MASTERS-D study: a prospective, multicenter, pragmatic, observational, data-monitored trial of minimally invasive fusion to treat degenerative lumbar disorders, one-year follow-up. Cureus. (2016) 8:e640. 10.7759/cureus.640



      DOI



      PMC



      PubMed

    1. Obenchain TG. Laparoscopic lumbar discectomy: case report. J Laparoendosc Surg. (1991) 1:145–9. 10.1089/lps.1991.1.145



      DOI



      PubMed

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