Long term effects of subfascial drainage for iatrogenic durotomy in lumbar spine surgery

Abstract

INTRODUCTION: Dural tears (DT) are one of the most frightful and most important complications that can be encountered in lomber surgeries. In our study, we were investigated the repair methods of DT or durotomies following posterior lumbar surgery and the efficacy of subfascial drainage on the treatment. METHODS: 32 Patients who developed postoperative cerebrospinal fluid (CSF) fistulae because of posterior dural injury during surgery were retrospectively collected between the years 2011-2016 who underwent lumbar disc herniation, spinal stenosis, instrumentation-fusion operations such as spondylolistesis, lumbar vertebral fracture and revision surgeries. All patients had postoperative subfascial drain which were removed in group A on day 7 and in group B on day 3. RESULTS: 373 patients who were operated on due to the lomber pathologies, 32 (8.5%) patients with the posterior DT during surgery were developed CSF fistulae postoperatively. The mean FU period of the patients was 68.5 +- 13.1 days. 6 patients were operated for DT due to pseudomeningocele(PM) (2 patients, 11.1%) and duro-cutaneous fistula(DCF) (4 patients, 22.2%) in group A. 9 patients were operated for PM (3 patients, % 21.4) and DCF (6 patients,% 42.9) in Group B. There were significant differences developing PM and DCF betweeen the groups.(p=0.04 and p=0.05). DISCUSSION AND CONCLUSION: Many DT repairing methods after lumbar surgeries were identified and still controversial. Intraoperative subfascial drains seems effective in our study, the development of PM and DCF decreases with the length of drainage. Long drainage doesn't cause an additional infection, but it has disadvantages such as prolonged hospital stay and increased treatment costs.

Keywords

• cerebrospinal fluid (csf) fistula
• duro-cutaneous fistula
• pseudomeningocele
• dural tear
• durotomy