Abstract
Background
In spite of the fact that Incidental dural tears (IDTs) is being a well known intra-operative complication during lumbar surgery, true incidence is not accurately known, and different techniques have been suggested for management.
Aim of the Work: Detect incidence of incidental dural tears (IDTs) in lumbar surgery with evaluation of our intraoperative technique used for management.
Materials and Methods
A total number of 834 degenerative lumbar spine cases were reviewed, during the period from 2008 till 2013 in our institutions. Among those cases 191 were recurrent cases. Cases complicated with IDTs were identified, managed intra-operatively using our technique that was based on many layers tight closure, cases with persistent leak that needs re-operation are identified and reviewed.
Results
The incidence of ITDs during lumbar surgery in our series was 7.3% (61 of 834 cases) During primary surgery it was 5.9% (38 of 643 cases), among recurrent cases it was 12% (23 of 191 cases), all cases were repaired intra-operative using 3–0 vicryle suture and a muscle graft was sutured as an enforcing layer, tight closure of fascia, subcutanous, subcuticular layers and skin, no sub-fascial drains used. One case showed persistent leakage and 2 cases complicated with pseudomeningocele, cases of pseudo meningocele were managed conservatively and the case of leakage re-operated, with no further complications.
Conclusion
IDTs is a common complication in lumbar surgery with a higher incidence in recurrent cases. The corner stone in the management of IDTs is intra-operative identification and tight closure in many layers that was proved by our surgical technique, a success rate was 98.4%, one case of 61 cases (1.6%) needed a second operation.