“RATE OF CSF LEAKAGE FOLLOWING PRIMARY REPAIR OF INCIDENTAL DUROTOMY IN LUMBAR SPINE SURGERY USING FIBRIN GLUE”
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Keywords
Incidental durotomy, lumbar spine surgery, cerebrospinal fluid leak, fibrin glue, dural repair.
Abstract
Introduction: Incidental durotomy is a frequent complication in lumbar spine surgery, often leading to cerebrospinal fluid (CSF) leakage, pseudomeningocele, and wound-related morbidity if not promptly managed. The development of effective repair strategies is crucial for reducing postoperative complications and improving patient outcomes.
Objective: To compare the efficacy of the use of fibrin glue augmentation/enhancement after primary microsurgical suturing in the repair of incidental durotomy during lumbar spine surgery.
Materials and Methods: Patients with incidental durotomy during the course of lumbar spine surgery were repaired by primary closure, utilising microsurgical sutures under magnification. The suture line was reinforced with fibrin glue. The postoperative management used bed rest, hydration and wound care. The status after surgical intervention was reassessed after one week, one month, and three months to determine the CSF leakage, pseudo meningocele or wound complications. Data were recorded and analysed prospectively. Results: The number of patients was 60. The CSF leakage was 6.7%, the pseudomeningocele was 5.0%, and the wound infection was 3.3%. Totally, 93.3 per cent of patients developed no postoperative CSF leak, which indicates a high effectiveness of this treatment option as the fibrin glue becomes an adjunct to suturing. The majority of complications were conservatively treated, with no single case necessitating reoperation.
Conclusion: Fibrin glue augmentation of surgically repaired wounds forms a safe reparation process for postoperative CSF leakage incidents and the associated complications. This is an effective and safe method for treating the condition, and it can be easily incorporated into standard surgery.
References
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Dr Hameed Ullah
Assistant Professor, Khalifa Gul Nawaz Teaching Hospital Bannu, Pakistan
Dr Afsar Khan
Consultant Neurosurgeon, Khalifa Gul Nawaz Teaching Hospital Bannu, Pakistan
Dr Muhammad Azam
Assistant Professor, Neurosurgery Department, Saidu Teaching Hospital Swat KPK, Pakistan
Dr Umar Zia Khan
Consultants Orthopedics Surgeon/ Assistant Professor, Kulsum International Hospital / PAF Hospital Islamabad, Pakistan
Dr Raza Hassan
Assistant Professor, Department of Orthopaedics, Northwest General Hospital and Research Centre, Pakistan
Dr Naseer Hassan
Associate Professor/ Chairman, Neurosurgery and Neurotrauma Department, Nowshera Medical College / Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan