Management of Persistent Cerebrospinal Fluid Leakage Following Thoraco-lumbar Surgery
Asian Spine Journal
; : 157-162, 2012.
Article
de En
| WPRIM
| ID: wpr-68128
Bibliothèque responsable:
WPRO
ABSTRACT
STUDY DESIGN: This was a retrospective study of patients who had developed a dural tear after thoracic and lumbar spine surgery that was not recognized during the surgery, and was treated either by lumbar drainage or over-sewing of the wounds. PURPOSE: To revisit the treatment strategies in postoperative dural leaks and present our experience with over-sewing of the wound and lumbar drainage. OVERVIEW OF LITERATURE: Unintended durotomy is a frequent complication of spinal surgery. Management of subsequent cerebrospinal fluid leakage remains controversial. There is no distinct treatment guideline according to the etiology in the current literature. METHODS: The records of 368 consecutive patients who underwent thoracic and/or lumbar spine surgery from 2006 throug h 2010 were retrospectively reviewed. Seven cerebrospinal fluid fistulas and five pseudomeningoceles were noted in 12 (3.2%) procedures. Cerebrospinal fluid diversion by lumbar drainage in five pseudomeningoceles and over-sewing of wounds in seven cerebrospinal fluid fistulas employed in 12 patients. Clinical grading was evaluated by Wang. RESULTS: Of the 12 patients who had a dural tear, 5 were managed successfully with lumbar drainage, and 7 with oversewing of the wound. The clinical outcomes were excellent in 9 patients, good in 2, and poor in 1. Complications such as neurological deficits, or superficial or deep wound infections did not develop. A recurrence of the fistula or pseudomeningocele after the treatment was not seen in any of our patients. CONCLUSIONS: Pseudomeningoceles respond well to lumbar drainage, whereas over-sewing of the wound is an alternative treatment option in cerebrospinal fluid fistulas without neurological compromise.
Mots clés
Texte intégral:
1
Indice:
WPRIM
Sujet Principal:
Récidive
/
Rachis
/
Cicatrisation de plaie
/
Infection de plaie
/
Drainage
/
Études rétrospectives
/
Fistule
Type d'étude:
Guideline
/
Observational_studies
Limites du sujet:
Humans
langue:
En
Texte intégral:
Asian Spine Journal
Année:
2012
Type:
Article