Skip to main content
SpringerLink
Log in

Iatrogenic dural tear in endoscopic lumbar spinal surgery: full endoscopic dural suture repair (Youn’s technique)

  • Case Report
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Background

With the advancement of minimally invasive spinal surgery, endoscopic lumbar decompression has been widely used for the treatment of degenerative lumbar spinal diseases. Iatrogenic dural tear is a relatively common complication in endoscopic lumbar spinal surgery. The golden standard of treatment for iatrogenic dural tear is immediate open conversion and direct repair under microscopic visualization. Recently, most of endoscopic spinal surgery is performed under local anesthesia. So, conversion to open surgery is very embarrassing situation because of the need of additional general anesthesia. But, direct endoscopic dural repair is very difficult procedure due to the limitation of manipulation. No report showed direct dural suture under full endoscopic situation.

Purpose

The purpose of this surgical technique is to provide a method of full endoscopic dural suture repair without conversion to open surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Epstein NE (2007) The frequency and etiology of intraoperative dural tears in 110 predominantly geriatric patients undergoing multilevel laminectomy with noninstrumented fusions. J Spinal Disord Tech 20(5):380–386

    Article  PubMed  Google Scholar 

  2. Bosacco SJ, Gardner HJ, Guille JT (2001) Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res 389:238–247

    Article  Google Scholar 

  3. Jones AA, Stambough JL, Balderston RA, Rothman RH, Booth RE Jr (1989) Long-term results of lumbar spine surgery complicated by unintended incidental durotomy. Spine 14:443–446

    Article  PubMed  CAS  Google Scholar 

  4. Khan MH, Rihn J, Steele G, Davis R, Donaldson WF 3rd, Kang JD, Lee JY (2006) Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine 31:2609–2613

    Article  PubMed  Google Scholar 

  5. Dafford EE, Anderson PA (2015) Comparison of dural repair techniques. Spine J 15:1099–1105

    Article  PubMed  Google Scholar 

  6. Epstein NE (2010) Dural repair with four spinal sealants: focused review of the manufacturers’ inserts and the current literature. Spine J 10:1065–1068

    Article  PubMed  Google Scholar 

  7. Grannum S, Patel MS, Attar F, Newey M (2014) Dural tears in primary decompressive lumbar surgery. Is primary repair necessary for a good outcome? Eur Spine J 23(4):904–908

    Article  PubMed  PubMed Central  Google Scholar 

  8. Guerin P, El Fegoun AB, Obeid I, Gille O et al (2012) Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury 43(4):397–401

    Article  PubMed  Google Scholar 

  9. Epstein NE (2013) A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery. Surg Neurol Int 4(Suppl 5):S301–S317

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine: management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80(12):1728–1732

    Article  PubMed  CAS  Google Scholar 

  11. Miller PR, Elder FW Jr (1968) Meningeal pseudocysts (meningocele spurius) following laminectomy. Report of ten cases. J Bone Joint Surg Am 50(2):268–276

    Article  PubMed  CAS  Google Scholar 

  12. Karaeminogullari O, Atalay B, Sahin O, Ozalay M et al (2005) Remote cerebellar hemorrhage after a spinal surgery complicated by dural tear: case report and literature review. Neurosurgery 57(1 Suppl):E215

    PubMed  Google Scholar 

  13. Shaffrey CI, Spotnitz WD, Shaffrey ME, Jane JA (1990) Neurosurgical applications of fibrin glue: augmentation of dural closure in 134 patients. Neurosurgery 26(2):207–210

    Article  PubMed  CAS  Google Scholar 

  14. Oertel JM, Burkhardt BW (2017) Full endoscopic treatment of dural tears in lumbar spine surgery. Eur Spine J 26(10):2496–2503

    Article  PubMed  Google Scholar 

  15. Sun MJ, Gao SM, Wang YH (2011) Simultaneous intra-operative repair for inadvertent dural tear under posterior lumbar disk scope. Orthop Surg 3(3):188–192

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shibayama M, Mizutani J, Takahashi I, Nagao S et al (2008) Patch technique for repair of a dural tear in microendoscopic spinal surgery. J Bone Joint Surg Br 90(8):1066–1067

    Article  PubMed  CAS  Google Scholar 

  17. Chou D, Wang VY, Khan AS (2009) Primary dural repair during minimally invasive microdiscectomy using standard operating room instruments. Neurosurgery 64(5 Suppl 2):356–358

    PubMed  Google Scholar 

  18. Than KD, Wang AC, Etame AB, La Marca F et al (2008) Postoperative management of incidental durotomy in minimally invasive lumbar spinal surgery. Minim Invas Neurosurg 51(5):263–266

    Article  CAS  Google Scholar 

  19. Galarza M, Gazzeri R, Alfaro R, de la Rosa P et al (2018) Evaluation and management of small dural tears in primary lumbar spinal decompression and discectomy surgery. J Clin Neurosci 50:177–182

    Article  PubMed  Google Scholar 

  20. Ahn Y, Lee HY, Lee SH, Lee JH (2011) Dural tears in percutaneous endoscopic lumbar discectomy. Eur Spine J 20(1):58–64

    Article  PubMed  Google Scholar 

  21. Guerin P, El Fegoun AB, Obeid I, Gille O et al (2012) Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury 43(4):397–401

    Article  PubMed  Google Scholar 

  22. Papavero L, Engler N, Kothe R (2015) Incidental durotomy in spine surgery: first aid in ten steps. Eur Spine J 24(9):2077–2084

    Article  PubMed  Google Scholar 

  23. Tafazal SI, Sell PJ (2005) Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J 14(3):287–290

    Article  PubMed  Google Scholar 

  24. Gautschi OP, Stienen MN, Smoll NR, Corniola MV et al (2014) Incidental durotomy in lumbar spine surgery–a three-nation survey to evaluate its management. Acta Neurochir (Wien) 156(9):1813–1820

    Article  Google Scholar 

  25. Hodges SD, Humphreys SC, Eck JC, Covington LA (1999) Management of incidental durotomy without mandatory bed rest. A retrospective review of 20 cases. Spine 24(19):2062–2064

    Article  PubMed  CAS  Google Scholar 

  26. Narotam PK, Jose S, Nathoo N, Taylon C, Vora Y (2004) Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine 29(24):2861–2867

    Article  PubMed  Google Scholar 

  27. Cammisa FP Jr, Girardi FP, Sangani PK et al (2000) Incidental durotomy in spine surgery. Spine 25:2663–2667

    Article  PubMed  Google Scholar 

  28. Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P et al (2009) Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J 18(8):1169–1174

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Myungeun Hospital, 184 World Cup-daero, Yeonje-gu, Busan, 47521, South Korea

    Jong Ki Shin, Myung Soo Youn & Yoon Jae Seong

  2. Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea

    Tae Sik Goh & Jung Sub Lee

Authors
  1. Jong Ki Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Myung Soo Youn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoon Jae Seong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tae Sik Goh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jung Sub Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Myung Soo Youn.

Ethics declarations

Conflict of interest

None of the authors has any potential conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shin, J.K., Youn, M.S., Seong, Y.J. et al. Iatrogenic dural tear in endoscopic lumbar spinal surgery: full endoscopic dural suture repair (Youn’s technique). Eur Spine J 27 (Suppl 3), 544–548 (2018). https://doi.org/10.1007/s00586-018-5637-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-018-5637-6

Keywords

Search

Navigation