Evidence-based clinical practice guidelines for the treatment of dural tears and the consequent cerebrospinal fluid leak during spine surgery / 中华外科杂志

ABSTRACT

Dural tears (DT) and the consequent cerebral spinal fluid (CSF) leak are not rare in spine surgeries. CSF leak can be troublesome, leading to pseudomeningocele, cutaneous CSF fistula, and meningitis. Revision surgery is unavoidable in some cases. The reported incidences of DT and CSF leak are different according to the various pathologies. Ossification of the posterior longitudinal ligament, revision spine surgery and multi-segment laminectomy have higher risks for DT. Various techniques have been described to manage this complication, such as bed rest, repair with dural substitutes, fibrin glue, gelatin sponge, lumbar drain, muscle flap, etc.Through objective evaluation of the evidence and transparency in the process of making recommendations, it is Chinese Association of Orthopaedic Surgeons′ goal to develop evidence-based clinical practice guidelines for the treatment of incidental DT and the consequent CSF leak during spine surgery. The current clinical guidelines focus on 9 clinical questions and the strength of recommendations were made based on the quality of the literature. The work group considers that this guideline recommendations aim to assist in delivering optimum, efficacious treatment and functional recovery from this complication.