ABSTRACT
Cerebrospinal fluid leakage is one of the common complications of spinal surgeries. The causes of the leak can be dural tears during surgery procedure and this is a medical problem.Cerebrospinal fluid is a physiological fluid that protects the brain and maintains intracranial pressure. If it's not handled properly, it will cause persistent headaches, nausea, vomiting, and carry an increased risk of meningitis. Correct and effective dural suture and repair are the basis of recovery. The repair of dura mater is difficult to be alleviated by medicine, so it is very important to identify and repair cerebrospinal fluid leakage in time. In this review, the relevant studies in recent years are summarized. We discuss the pathogenesis of dural tears, diagnosis, repair methods. We provide references for clinicians to avoid delayed wound healing, wound infection, spinal canal and intracranial infection, pseudodural cyst, spinal cord nerve compression and other serious complications. This paper aims to assist in delivering efficacious treatment and recovery for patients.
ABSTRACT
Objective To compare the therapeutic effect of three treatments for cerebrospinal fluid leakage induced by surgical operation of spinal fracture combined with dural injury.Methods From June 2005 to June 2010,64 patients with cerebrospinal fluid leakage after surgery to spinal fracture combined with dural injury were analyzed.Patients were treated with positioning adjustment and incision pressure dressing (Group A,n =21),with cerebrospinal fluid leakage drainage via a lumbar percutaneous subarachnoid catheter (Group B,n =21),and with continuous wound drainage followed by catheter removing and wound closure when wound is completely healed (Group C,n =22).Time to stop cerebrospinal fluid leaking from a surgical incision,wound healing time,success rate in the primary intervention and postoperative complications were reviewed among these groups.Results In Group A,the incisional cerebrospinal fluid leakage disappeared at (19.0 ±3.9)days,with healing time of (25.0 ± 4.6)days.The primary wound healing was achieved in 13 patients but failure to the primary intervention occurred in 8 patients,of whom 6 patients presented complications which were then cured.In Group B,the incisional cerebrospinal fluid leakage disappeared at (3.0 ± 1.0) days,with healing time of (16.0 ± 2.6) days.There were 15 patients with primary wound healing but 6 patients got healing after further treatment,with no complications occurred.In Group C,there was no incisonal cerebrospinal fluid leakage or complications and all patients presented primary wound healing in a period of (13.0± 1.0)days.Healing time was shorter and success rate in the primary intervention in Group C was higher than those in Groups A and B (P ＜ 0.05).Conclusions Continuous wound drainage till catheter removal and wound closure on complete wound healing is a good choice for treating cerebrospinal fluid leakage induced by surgical operation of spinal fracture combined with dural injury,for it has advantages of good incisional healing,high success rate and few complications in the primary treatment.
ABSTRACT
Objective To investigate curative outcomes of the limited-incision surgery under cold light source for treating calcified lumbar disc protrusion. Methods A total of 36 patients with calcified lumbar disc protrusion underwent limited-incision surgery under cold light visualization from January 2000 to June 2005. The patients were maintained at a prone position. The operation was carried out under local anesthesia. A longitudinal skin incision around 3 cm in length was made. After the inferior border of the vertebral plate and the intervertebral space were exposed, a lamina retractor was inserted above the superior border of the articular process. Then a fenestration and a discectomy were performed under cold light visulization. Results The operative time was 75.3?3.5 min and the intraoperative blood loss was 100.6?5.5 ml. Cerebrospinal fluid leakage occurred in 3 patients. All the 36 patients were followed for 6~60 months (mean, 27 months). Symptoms of low back pain, lower limb pain, and intermittent limping disappeared completely in all the 36 patients. According to the Nakai standard, the rate of excellent or good results was 94.4% ( 34/36 ). Conclusions Limited-incision surgery under cold light source for the treatment of calcified lumbar disc protrusion offers advantages of simplicity of performance, minimal invasion, and satisfactory outcomes.