Dural Tear Intraop
- Incidence 1-17%
- RF
- Revision
- Decompression for stenosis
- Age
- Ossified LF
- High BMI
- Challenging tear
- Nerve root
- Anterior spine (from posterior approach)
- Management
- Expose tear
- Proximal and distal extension oof decompression
- Protect neural elements
- Watch sucker
- Remove sticker on sucker
- Patties to push in roots
- Nerve hooks to lift edge of dura
- Closure
- Primary
- Watertight closure with 5-0 prolene
- Fibrin augment
- Alternative
- Dural patch
- Fat patch
- Fascia path
- Check – Valsalva (40mmHg x 20s)
- Primary
- Alternative
- Dural drain
- Post op bed rest (24-48h) (no evidence)
- IV caffeine
- Expose tear
Dural Tear Post Op (Pseudomeningocele)
- Causes
- Missed dural tear
- Failed repair
- Spontaneous late tear
- Symptoms and Signs
- Post op postural headache
- N/V
- Back pain and fullness
- Abducens nerve palsy (traction)
- Fistula
- SSI
- Asymptomatic
- Monitor; anticipate scarring and resolution 1 year
- Symptomatic early
- MRI
- r/o infection
- Monitor
- Symptomatic persistent
- Primary repair (as aforementioned)
- Dural patch
- Fibrin augment
- Complete the decompression
- Visualze the entire reppair
- 5-0 non absorbably monofilament
- Watertight closure
- Valsavla at 30mmHg for 3 seconds
- Fibrin glue augment
- 24h bedrest
- If persist, return to OR an/or insertion of lumbar drain
The Spine Book 