171 - Management of Intended Durotomy in Elective Intradural Minimally Invas...

#171 Management of Intended Durotomy in Elective Intradural Minimally Invasive Spine Surgery

MIS Techniques and Outcomes

Poster Presented by: I. Takagi

Author(s):

I. Takagi (1)
R. Fontes (1)
J. O'Toole (1)

(1) Rush University Medical Center, Chicago, IL, USA

Abstract

Objective: Watertight dural closure after elective surgery for intradural spinal pathology is important for an uncomplicated postoperative course. There are several closure techniques and methods to avoid spinal fluid leaks many of which include postoperative bedrest that lengthens hospitalization and recovery time. The authors describe their experience in a consecutive series of patients that underwent minimally invasive spine surgery (MIS) for intradural lesions.

Methods: A retrospective review of a prospectively collected database of surgical cases was performed revealing 18 consecutive patients that underwent MIS surgery via tubular retractor for intradural spinal pathology between 2006 and 2012. All cases used a primary suture dural closure using specialized MIS instruments with adjuvant fibrin sealant. All patients were allowed full activity less than 24 hours after surgery.

Results: Surgery pathology was neoplastic (13 patients), congenital (3 patients), vascular (1 patient) and degenerative (1 patient). The most common spinal region treated was lumbar (9 patients) followed by thoracic (6 patients), cervical (2 patients) and sacral (1 patient). The mean age at surgery was 54.1 years, estimated blood loss was 117 ml and operative time was 168 minutes. The median length of stay was 72 hrs. The rate of postoperative headache, nausea/vomiting and diplopia was 0%. No cases of cutaneous spinal fluid fistula or pseudomeningocele were identified at follow-up, and no patient required revision surgery.

Conclusions: In this consecutive series of patients undergoing elective MIS for intradural spinal pathology, successful primary dural repair was achieved with no incidence of complications attributable to the intended durotomy and with early mobilization of these patients.