Cervical Posterior Durotomy Repair
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The purpose of this manuscript is to give an overview of cervical posterior durotomy repair.
Cervical posterior durotomies (CPD) can occur for different reasons.
First, CPD is the standard approach to reach intradural pathologies such as tumor, cysts, bleeding, or vascular.
Second, CPD is necessary for unintended dural tears during extradural procedures.
The incidence of dural violation during decompression or posterior instrumentation is very rare, but the complications rising for this event can be serious. Only very small case series are available. No specific literature is available for the management of cervical posterior durotomy repair.
It has to be differentiated between intended and unintended durotomy. From a surgical technique standpoint, it has to be seen completely different.
Intended durotomy to reach intradural pathology should be performed in a standard approach to visualize the dura as much as necessary. Midline or lateral straight opening of the dura and placing of holding sutures to open up the cavity. When finished watertight suturing followed by additional sealing tissue and/or fibrin glue can be performed to minimize the risk of CSFL. Placing of additional lumbar CSF drainage can be performed to reduce the intradural pressure.
In unintended dural tears the goal of surgery as to be revised on closing the defect and preventing postoperative CSFL. The complete visualization and closure of the defect is the main goal. Here again, suturing is the best option. If not possible anymore, try to minimize the gap, and put additional sealant layers and/or fibrin glue on the defect.
Different products are available and described, but there is no evidence of one being superior to others.
Overall dural closure can be challenging. In case of CSFL, an early revision should be done to prevent further complications like infection or subdural hematoma.
- 2.Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P, Cheng BC, Faught R, Welch WC. Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J. 2009;18(8):1169–74. https://doi.org/10.1007/s00586-009-0928-6.CrossRefPubMedPubMedCentralGoogle Scholar