• World Neurosurg · Nov 2017

    Case Reports

    Anterior Lumbar Dural Tear: A Transthecal Route for Primary Closure after Iatrogenic Durotomy.

    • Jonathan Nakhla, Rani Nasser, Rafael de la Garza Ramos, Andrew Kobets, Adam Ammar, Murray Echt, Yaroslav Gelfand, Merritt Kinon, and Reza Yassari.
    • Department of Neurological Surgery, Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
    • World Neurosurg. 2017 Nov 1; 107: 522-525.

    BackgroundDurotomies are not infrequent in spine surgery and have increased complication rates. Primary repair is the gold standard and is feasible when access is not limited by the anatomy. A patient who presented 1 week after spinal fusion with cerebrospinal fluid (CSF) leak underwent a novel transthecal approach to repair an anterior dural tear.ObjectiveTo demonstrate the feasibility, durability, and safety of a transthecal reconstruction to repair an anterior dural tear.MethodsA patient with spinal stenosis at L4-L5 and a spondylolisthesis at L5-S1 underwent an L4-S1 posterior lumbar interbody fusion. The procedure was complicated by a CSF leak during graft placement of the anterior dura. This location did not allow for a primary closure, and a fat graft was placed with fibrin glue. Nine days later, the patient developed postural headaches, and CSF was leaking from the wound. The patient underwent an exploration, and the most lateral aspect of the tear was visualized when retracting medially, although not enough for a primary repair. A posterior durotomy was made and the anterior dural tear was repaired from the inside.ResultsThe patient symptoms resolved and had radiologic improvement of the pseudomeningocele. This represents the first reported transthecal route to repair an anterior dural tear in the lumbar spine. The procedure was technically feasible, effective, and durable, with the patient having complete resolution of his CSF leak.ConclusionsDorsal transthecal access to the ventral aspect of the lumbar thecal sac for inadvertent anterior dural tears is a safe, feasible, and durable surgical management strategy.Copyright © 2017 Elsevier Inc. All rights reserved.

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