Advances in the Management of Spinal Durotomy
Main Article Content
Abstract
Spinal durotomy, whether incidental or intentional, requires a watertight closure to prevent potentially significant complications. As a result of relatively recent technological advancements and research, spine surgeons now have many options for both intra-operative dural repair as well as managing post-operative cerebrospinal fluid (CSF) leak. This review presents a comprehensive overview of the current and historical treatment strategies in the management of spinal durotomy. Intra-operative treatment of intentional and incidental durotomies through a variety of available dural sutures, dural sealants and other patches and grafts as well as post-operative CSF leak management strategies including conservative measures, epidural blood patches, CSF diversion therapies and definitive surgical repair will be presented.
Article Details
How to Cite
KARNATI, Tejas; KULUBYA, Edwin Samuel; KIM, Kee D..
Advances in the Management of Spinal Durotomy.
Medical Research Archives, [S.l.], v. 8, n. 9, sep. 2020.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2190>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v8i9.2190.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Rodriguez-olaverri JC, Zimick NC, Merola A, et al. Comparing the clinical and radiological outcomes of pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis versus unilateral transforaminal lumbar interbody fusion (TLIF) with posterior fixation using anterior cages. Spine. 2008;33(18):1977-81.
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4. Mcmahon P, Dididze M, Levi AD. Incidental durotomy after spinal surgery: a prospective study in an academic institution. J Neurosurg Spine. 2012;17(1):30-6.
5. Williams BJ, Sansur CA, Smith JS, et al. Incidence of unintended durotomy in spine surgery based on 108,478 cases. Neurosurgery. 2011;68(1):117-23.
6. Cammisa FP, Girardi FP, Sangai PK, et al. Incidental durotomy in spine surgery. Spine. 2000;25:2663–7.
7. Tani T, Ushida T, Ishida K, et al. Relatively safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior longitudinal ligament. Spine. 2001;27:2491–8.
8. Mochizuki M., Koda M. (2019) Management of Anterior Durotomy in Cervical Spine. In: Koller H., Robinson Y. (eds) Cervical Spine Surgery: Standard and Advanced Techniques. Springer, Cham
9. Barth M, Tuettenberg J, Thomé C, Weiss C, Vajkoczy P, Schmiedek P. Watertight dural closure: is it necessary? A prospective randomized trial in patients with supratentorial craniotomies. Neurosurgery. 2008;63(4 Suppl 2):352-8.
10. Mulder M, Crosier J, Dunn R. Cauda equina compression by hydrogel dural sealant after a laminotomy and discectomy: case report. Spine. 2009;34(4):E144-8.
11. Tseng WL, Xiao F. Duraseal thecal sac compression after lumbar discectomy causing radiculopathy. Spine J. 2015;15(8):1892-3.
12. Strong MJ, West GA, Woo H, et al. A Pivotal Randomized Clinical Trial Evaluating the Safety and Effectiveness of a Novel Hydrogel Dural Sealant as an Adjunct to Dural Repair. Oper Neurosurg (Hagerstown). 2017;13(2):204-212.
13. Buddeberg BS, Bandschapp O, Girard T. Post-dural puncture headache. Minerva Anestesiol. 2019 May;85(5):543-553.
14. Pagani-Estévez GL, Cutsforth-Gregory JK, Morris JM, Mokri B, Piepgras DG, Mauck WD, Eldrige JS, Watson JC. Procedural predictors of epidural blood patch efficacy in spontaneous intracranial hypotension. Reg Anesth Pain Med. 2019 Jan 13.
15. Maycock NF, van Essen J, Pfitzner J. Post-laminectomy cerebrospinal fluid fistula treated with epidural blood patch. Spine (Phila Pa 1976) 1994; 19:2223–2225.
16. Fridley JS, Jea A, Glover CD, et al. Symptomatic postsurgical cerebrospinal fluid leak treated by aspiration and epidural blood patch under ultrasound guidance in 2 adolescents. J Neurosurg Pediatr 2013; 11:87–90.
17. McCormack BM, Taylor SL, Heath S, et al. Pseudomeningocele/CSF fistula in a patient with lumbar spinal implants treated with epidural blood patch and a brief course of closed subarachnoid drainage. A case report. Spine (Phila Pa 1976) 1996; 21:2273–2276.
18. McCormack BM, Taylor SL, Heath S, et al: Pseudomeningocele/CSF fistula in a patient with lumbar spinal implants treated with epidural blood patch and a brief course of closed subarachnoid drainage. A case report. Spine 21:2273–2276, 1996
19. Sandwell S, Walter K, Westesson PL. Pseudomeningocele Aspiration and Blood Patch Effectively Treats Positional Headache Associated With Postoperative Lumbosacral Pseudomeningocele. Spine. 2017;42(15):1139-1144.
20. Ghobrial GM, Maulucci CM, Viereck MJ, et al. Suture Choice in Lumbar Dural Closure Contributes to Variation in Leak Pressures: Experimental Model. Clin Spine Surg. 2017;30(6):272-275.
21. Chu CC, Pratt L, Zhang L, Hsu A, Chu A. A comparison of a new polypropylene suture with Prolene. J Appl Biomater. 1993;4(2):169-81.
22. Miller CM, Signal P, Jacobson II JH. Reduced anastomotic bleeding using new sutures with a needle-suture diameter ratio of one. Surgery 1987;101:156-160.
23. Dang M-C, Thacker JG, Hwang JC-S, Rodeheaver GT, Melton SM, Edlich RF. Some biomechanical considerations of polytetrafluoroethylene sutures. Archives of Surgery 1990;125:647-650.
24. Dafford EE, Anderson PA. Comparison of dural repair techniques. Spine J. 2015;15(5):1099-105.
25. Bakhsheshian J, Strickland BA, Patel NN, et al. The use of a novel perfusion-based cadaveric simulation model with cerebrospinal fluid reconstitution comparing dural repair techniques: a pilot study. Spine J. 2017;17(9):1335-1341.
26. Megyesi JF, Ranger A, Macdonald W, Del maestro RF. Suturing technique and the integrity of dural closures: an in vitro study. Neurosurgery. 2004;55(4):950-4.
27. Ebel F, Wanderer S, Beck J, Raabe A, Ulrich CT. The Optimal Dura Closure Technique and Material – An In-Vitro Evaluation. J Neurol Surg A Cent Eur Neurosurg. 201;78(1):24.
28. Cain JE, Dryer RF, Barton BR. Evaluation of dural closure techniques. Suture methods, fibrin adhesive sealant, and cyanoacrylate polymer. Spine. 1988;13(7):720-5.
29. Hannallah D, Lee J, Khan M, Donaldson WF, Kang JD. Cerebrospinal fluid leaks following cervical spine surgery. J Bone Joint Surg Am. 2008;90(5):1101-5.
30. 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. 1989;71(7):984-7.
31. Eismont FJ, Wiesel SW, Rothman RH. Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am, 63A (1981), pp. 1132-1136.
32. Foyt D, Johnson JP, Kirsch AJ, Bruce JN, Wazen JJ. Dural closure with laser tissue welding. Otolaryngol Head Neck Surg. 1996;115(6):513-8.
33. Levy DI, Sonntag VK. Titanium dural clip testing. Technical note. J Neurosurg. 1994;81(6):947-9.
34. Kerr EE, Panchal RR, Kim KD (2014) Refractory Cervical Spinal Pseudomeningocele Successfully Treated with a Polycarbonate Face Mask: Technical Note. JSM Neurosurg Spine 2(1): 1011.
35. Mayfield FH, Kurokawa K. Watertight closure of spinal dura mater. Technical note. J Neurosurg. 1975;43(5):639-40.
36. Shimada Y, Hongo M, Miyakoshi N, et al. Dural substitute with polyglycolic acid mesh and fibrin glue for dural repair: technical note and preliminary results. J Orthop Sci. 2006;11(5):454-8.
37. Tisseel: Package Insert and Label Information. Italian version, March 2013, in, 2013. http://druginserts.com/lib/other/meds/tissell-1.
38. Green AL, Arnaud A, Batiller J, et al. A multicentre, prospective, randomized, controlled study to evaluate the use of a fibrin sealant as an adjunct to sutured dural repair. Br J Neurosurg. 2015;29(1):11-17.
39. Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P, Cheng BC, Faught R, et al. Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J. 2009; 18:1169–1174.
40. US Food & Drug Administration. Premarket Approval (PMA). https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMA/pma.cfm?id=P080013. Accessed September 22, 2017.
41. Kim KD, Ramanathan D, Highsmith J, et al. DuraSeal Exact Is a Safe Adjunctive Treatment for Durotomy in Spine: Postapproval Study. Global Spine J. 2019;9(3):272-278.
42. Sutterlin CE, Grogan DP, Ogden JA. Diagnosis of developmental pathology of the neuraxis by magnetic resonance imaging. J Pediatr Orthop. 1987;7(3):291-7.
43. Miller PR, Elder FW. Meningeal pseudocysts (meningocele spurius) following laminectomy. Report of ten cases. J Bone Joint Surg Am. 1968;50(2):268-76.
44. Lee KS, Hardy IM. Postlaminectomy lumbar pseudomeningocele: report of four cases. Neurosurgery. 1992;30(1):111-4.
45. Sutterlin CE, Grogan DP, Ogden JA. Diagnosis of developmental pathology of the neuraxis by magnetic resonance imaging. J Pediatr Orthop. 1987;7(3):291-7.
46. Kolawole TM, Patel PJ, Naim-ur-rahaman . Post-surgical anterior pseudomeningocele presenting as an abdominal mass. Comput Radiol. 1987;11(5-6):237-40.
47. Weng YJ, Cheng CC, Li YY, et al. Management of giantpseudomeningoceles after spinal surgery. BMC Musculoskeletal Disorders. 2010.
48. Hyndman OR, Gerber WF. Spinal extradural cysts, congenital and acquired; report of cases. J Neurosurg. 1946;3(6):474-86.
49. Pau A. Postoperative "meningocele spurius". Report of two cases. J Neurosurg Sci. 1974;18(2):150-2.
50. Hawk MW, Kim KD. Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus. 2000;9(1):e5.
51. Couture D, Branch CL. Spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus. 2003;15(6):E6.
52. Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am. 1992;74(4):536-43.
53. Teplick JG, Peyster RG, Teplick SK, Goodman LR, Haskin ME. CT Identification of postlaminectomy pseudomeningocele. AJR Am J Roentgenol. 1983;140(6):1203-6.
54. Swanson HS, Fincher EF. Extradural arachnoidal cysts of traumatic origin. J Neurosurg 1947;4:530-538.
55. Lee KS, Hardy IM. Postlaminectomy lumbar pseudomeningocele: report of four cases. Neurosurgery 1992;30:111-114.
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