[Incidental durotomy: intraoperative aid in ten steps].

[Incidental durotomy: intraoperative aid in ten steps].
Oper Orthop Traumatol. 2019 Jul 19;:
Authors: Papavero L, Kothe R
Abstract
OBJECTIVE: Management of the intradural structures safely, closure of the dura according to the tear, and minimizing the epidural dead space.
INDICATIONS: Incidental durotomy (ID).
CONTRAINDICATIONS: None.
SURGICAL TECHNIQUE: 1. Bone removal until whole dural tear is visible (if necessary); 2. intradural inspection; 3. reposition the fibers; 4. perform an inside patch (if ID > 5 mm); 5. dural closure; 6. outside patch; 7. Valsalva maneuver; 8. epidural pedicled muscle flap; 9. multilayer wound closure; 10. lumbar drainage of cerebrospinal fluid (if necessary).
POSTOPERATIVE MANAGEMENT: Bed rest up to 48 h; analgesics.
RESULTS: The intraspinal part of 4020 surgeries performed with the aid of a microscope were evaluated. The overall prevalence of ID was 4.4%. The prevalence was lowest in virgin microdiscectomies (1.7%) and varied from 3.6% in decompression for spinal canal stenosis up to 14.5% in revision procedures. Of the overall 195 IDs, 127 occurred in primary surgeries and 68 in revision surgeries. In 107 primary surgeries, the individual surgical technique (InT) achieved a single stage closure of the ID in 96 procedures (89.7%). Among 20 virgin surgeries, the ten-step technique (10 ST) was successful in all cases (P = 0.21). Among 4...

Source: Operative Orthopadie und Traumatologie - July 18, 2019 Category: Orthopaedics Authors: Papavero L, Kothe R Tags: Oper Orthop Traumatol Source Type: research