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Combined thrombin and autologous blood for repair of lumbar durotomy

Abstract

Lumbar durotomy can be intended or unintended and can result in persistent cerebrospinal fluid (CSF) leak. Several methods are used to manage this complication including bed rest and CSF diversion. In this study, we theorize that the use of thrombin-soaked gel foam together with autologous blood laid on the sutured dural tear can prevent persistent CSF leak. A retrospective review of the records of patients who underwent lumbar surgery and had an unintended dural tear with CSF leak, comparing the outcome of patients who were submitted to thrombin-soaked gel foam together with autologous blood (group A) to patients treated by subfacial drain, tight bandage, and bed rest (group B). A total of 1371 patients had lumbar surgery, of whom 131 had dural tear. Group A included 62 patients, while group B included 69 patients. 8.1 % of group A patients had CSF leak as compared to 17.4 % of group B patients at postoperative day 14. The incidence of postoperative CSF leak and duration of postoperative hospital stay were statistically lower in group A than in group B (p < 0.05). Combining thrombin and autologous blood for repair of lumbar durotomy is an effective and a relatively cheap way to decrease CSF leak in the early postoperative period as well as decreasing postoperative hospital stay. It also resulted in decreased complications rate in the late postoperative period.

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Correspondence to Wael Mohamed Mohamed Moussa.

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This study was approved by the ethical committee in the Faculty of Medicine, Alexandria University, Egypt, and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

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The authors declare that they have no competing interests.

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Cite this article

Moussa, W.M.M., Aboul-Enein, H.A. Combined thrombin and autologous blood for repair of lumbar durotomy. Neurosurg Rev 39, 591–597 (2016). https://doi.org/10.1007/s10143-016-0707-x

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  • DOI: https://doi.org/10.1007/s10143-016-0707-x

Keywords

  • Lumbar
  • Dural tear
  • Cerebrospinal fluid
  • Thrombin
  • Autologous blood