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Incidence of Pinhole Type Durotomy and Subsequent Cerebrospinal Fluid Leakage Following Simple Laminectomy.

Bawany FI, Emaduddin M, Shahid M, Hussain M, Yousuful Islam M, Khan MS - Asian Spine J (2015)

Bottom Line: Univariate analysis showed that hypertension, diabetes and smoking were significantly associated with durotomy and increased CSF leakage by 16.72, 44.25, and 33.71 times, respectively.Multivariate analysis showed that only smoking and diabetes significantly increased the chances of leakage.Larger clinical studies on this lethal complication are required.

View Article: PubMed Central - PubMed

Affiliation: Dow University of Health Sciences, Karachi, Pakistan.

ABSTRACT

Study design: Cross sectional study.

Purpose: The purpose of this study was to determine the incidence and the associated risk factors of pinhole type of durotomy and cerebrospinal fluid (CSF) leakage following a simple laminectomy for spinal stenosis.

Overview of literature: The incidence of spinal stenosis is expected to rise with increasing life expectancy. Moreover, lumbar spinal stenosis is the most common indication for spinal injury in the geriatric population. It is therefore important to identify and prevent the risks associated with laminectomy, the most widely used surgical procedure for spinal stenosis. The serious complication of incidental dural tear or durotomy and subsequent CSF leakage has not been studied in the region of Southeast Asia.

Methods: In this cross sectional study, we included 138 adult patients (age>18 years), who underwent a simple laminectomy for lumbar stenosis between 2011 and 2012. CSF leakage was the main outcome variable. Patients' wounds were examined for CSF leakage up to 1 week postoperatively.

Results: The incidence of pinhole type durotomy and subsequent CSF leakage in our region was 8.7%. Univariate analysis showed that hypertension, diabetes and smoking were significantly associated with durotomy and increased CSF leakage by 16.72, 44.25, and 33.71 times, respectively. Multivariate analysis showed that only smoking and diabetes significantly increased the chances of leakage.

Conclusions: Glycemic control and cessation of smoking prior to a simple laminectomy procedure reduced the incidence of a dural tear. Larger clinical studies on this lethal complication are required.

No MeSH data available.


Related in: MedlinePlus

Percentage distribution of cerebrospinal fluid leakage.
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Figure 1: Percentage distribution of cerebrospinal fluid leakage.

Mentions: According to our results, CSF leakage was presented in 8.7% (n=12) of patients (Fig. 1). CSF leakage was significantly more in the 41-65 years old age group (n=8, 66.7%; p=0.008) and in patients with a BMI of 30.0-34.9 kg/m2 (n=7, 58.3%; p<0.001). Although insignificant, most of the CSF leakage was at the level of L4-L5 (n=10, 83.3%). None of the patients developed an infection or a hematoma due to CSF leakage. Hypertension (n=10, 83.3%), diabetes (n=9, 75%), and smoking (n=11, 91.7%) were significantly associated with CSF leakage (p<0.001). However, no significant association was found between drug use (n=3, 25%) and CSF leakage (p=0.087). These findings were shown in Table 2.


Incidence of Pinhole Type Durotomy and Subsequent Cerebrospinal Fluid Leakage Following Simple Laminectomy.

Bawany FI, Emaduddin M, Shahid M, Hussain M, Yousuful Islam M, Khan MS - Asian Spine J (2015)

Percentage distribution of cerebrospinal fluid leakage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522441&req=5

Figure 1: Percentage distribution of cerebrospinal fluid leakage.
Mentions: According to our results, CSF leakage was presented in 8.7% (n=12) of patients (Fig. 1). CSF leakage was significantly more in the 41-65 years old age group (n=8, 66.7%; p=0.008) and in patients with a BMI of 30.0-34.9 kg/m2 (n=7, 58.3%; p<0.001). Although insignificant, most of the CSF leakage was at the level of L4-L5 (n=10, 83.3%). None of the patients developed an infection or a hematoma due to CSF leakage. Hypertension (n=10, 83.3%), diabetes (n=9, 75%), and smoking (n=11, 91.7%) were significantly associated with CSF leakage (p<0.001). However, no significant association was found between drug use (n=3, 25%) and CSF leakage (p=0.087). These findings were shown in Table 2.

Bottom Line: Univariate analysis showed that hypertension, diabetes and smoking were significantly associated with durotomy and increased CSF leakage by 16.72, 44.25, and 33.71 times, respectively.Multivariate analysis showed that only smoking and diabetes significantly increased the chances of leakage.Larger clinical studies on this lethal complication are required.

View Article: PubMed Central - PubMed

Affiliation: Dow University of Health Sciences, Karachi, Pakistan.

ABSTRACT

Study design: Cross sectional study.

Purpose: The purpose of this study was to determine the incidence and the associated risk factors of pinhole type of durotomy and cerebrospinal fluid (CSF) leakage following a simple laminectomy for spinal stenosis.

Overview of literature: The incidence of spinal stenosis is expected to rise with increasing life expectancy. Moreover, lumbar spinal stenosis is the most common indication for spinal injury in the geriatric population. It is therefore important to identify and prevent the risks associated with laminectomy, the most widely used surgical procedure for spinal stenosis. The serious complication of incidental dural tear or durotomy and subsequent CSF leakage has not been studied in the region of Southeast Asia.

Methods: In this cross sectional study, we included 138 adult patients (age>18 years), who underwent a simple laminectomy for lumbar stenosis between 2011 and 2012. CSF leakage was the main outcome variable. Patients' wounds were examined for CSF leakage up to 1 week postoperatively.

Results: The incidence of pinhole type durotomy and subsequent CSF leakage in our region was 8.7%. Univariate analysis showed that hypertension, diabetes and smoking were significantly associated with durotomy and increased CSF leakage by 16.72, 44.25, and 33.71 times, respectively. Multivariate analysis showed that only smoking and diabetes significantly increased the chances of leakage.

Conclusions: Glycemic control and cessation of smoking prior to a simple laminectomy procedure reduced the incidence of a dural tear. Larger clinical studies on this lethal complication are required.

No MeSH data available.


Related in: MedlinePlus