Incidence of Dural Tears in Open versus Minimally Invasive Spine Surgery: A Single-Center Prospective Study

Incidental Dural Tears During Lumbar Spine Surgery: Prevalence and Evaluation of Management Outcomes

INTRODUCTION

 Incidental dural tears (IDTs) are sometimes observed as an intraoperative complication associated with lumbar spine surgery. Commonly, this complication is recognized and repaired during surgery, but if it is undiagnosed or inadequately treated, a variety of consequences may occur. Many techniques have been developed to treat cerebrospinal fluid (CSF) leakage, and each has its limitations.  Objectives: To assess the prevalence of incidental dural tears in lumbar spine surgeries and evaluate the outcomes of the sandwich technique in the management of this complication.

METHODS

A total of 92 patients who underwent lumbar spine surgery at the Royal Rehabilitation Center in Amman from January 2018 to December 2021 were retrospectively reviewed. Patients were divided into two groups: group A (patients without IDT) and group B (patients with IDT), where group B was repaired using the sandwich technique. The follow-up period was six months. Further, the sandwich technique involves repairing the dural defect with interlocking sutures, painting medical glue around the dural incision, covering this with gelatin sponge, and finally covering the gelatin sponge with medical glue again.

RESULTS

The overall prevalence of IDT in the study group was 14.1%. IDT was more common among elderly patients above the age of 60 (17.2%), females (16.7%), patients with multiple lumbar levels treated (66.7%), open approaches (21%), and those who had previous spinal surgery (72.7%). Most IDTs were diagnosed and managed intraoperatively (84.6%). Among those patients, only one complained of a surgical site infection. Patients in group B had a significantly higher postoperative length of hospital stay, amount of drainage, and operative time compared to group A (P<0.001). Regarding postoperative pain, patients in group B had significantly higher pain on the Numerical Pain Scale at day three post-operation compared to patients in group A (P<0.001).

CONCLUSION

Based on our results, the sandwich technique was effective in the management and prevention of CSF leakage. Further prospective studies with long-term follow-up are needed to confirm our findings.

Does Conventional Open TLIF cause more Muscle Injury when Compared to Minimally Invasive TLIF?-A Prospective Single Center Analysis

STUDY DESIGN

Prospective, observational.

OBJECTIVES

The aim of our study was to assess the amount of reduction in lean muscle mass (LMM) of multifidus muscle (MFM) between conventional open Transforaminal lumbar interbody fusion (CO-TLIF) as compared to Minimally invasive spine Transforaminal lumbar interbody fusion (MIS-TLIF).

METHODS

This study was conducted between 2017 and 2020. It included 100 patients divided into two groups, 50 patients treated with CO-TLIF, 50 treated with MIS-TLIF. Only patients undergoing single level, primary lumbar fusion at L4-5 or L5-S1 level for degenerative pathologies were included. All patients were assessed by magnetic resonance imaging (MRI) scans 1-year post surgery. Measurements were performed using ImageJ image processing program.

RESULTS

Mean percentage reduction in LMM in CO-TLIF group was 45.52 ± 12.36% and MIS-TLIF group was 25.83 ± 9.64% [statistically significant (t = 8.78, P < .001)]. Mean percentage reduction in LMM on side of cage insertion was 39.63 ± 15.96% and opposite side was 31.40 ± 15.01% [statistically significant (t = 9.06, P < .001)]. Mean reduction of LMM among males was 29.38 ± 15.23% and females was 40.42 ± 12.67% [statistically significant (t = -3.95, P < .001)].We observed significant but weak degree of correlation between age and percentage reduction of LMM (r = .22, P = .028).

CONCLUSION

Mean reduction in LMM was greater in CO-TLIF group as compared to MIS-TLIF. There was greater reduction in LMM in females and on side of cage insertion. We also found greater reduction in LMM with increasing age in both groups.

Biportal endoscopic discectomy versus tubular microscopic discectomy for treating single-level lumbar disc herniation in obese patients: a multicenter, retrospective analysis

PURPOSE

In microscopic lumbar discectomy in obese patients, a correlation is found between the operation time and increase in estimated blood loss according to the increase in body mass index; however, no studies have investigated the outcomes of biportal endoscopic lumbar discectomy in obese patients. Therefore, this study aimed to compare the clinical and radiographic outcomes of microscopic and endoscopic discectomy in obese patients with lumbar herniated discs.

METHODS

In this multicenter, retrospective study, clinical and radiological data were compared and analyzed in 73 obese patients with a body mass index of > 30 kg/m2 who underwent microscopic or biportal endoscopic lumbar discectomy. Clinical data on the visual analog scale (VAS), Oswestry disability index (ODI), and EuroQol-5D (EQ-5D) scores were measured, and radiological data were obtained using magnetic resonance imaging (MRI).

RESULTS

This study enrolled 43 patients who underwent microscopic discectomy and 30 who underwent biportal endoscopic discectomy. The VAS, ODI, and EQ-5D scores in both groups improved after surgery compared with those before surgery, although there was no difference between the two groups. Although there was a difference in the incidence of recurrent disc herniation confirmed by MRI after surgery, no difference was found in the number of patients requiring surgery between the two groups.

CONCLUSION

In obese patients with lumbar disc herniation that was not improved with conservative treatment, no significant clinical or radiological differences in outcomes were noted between microscopic and biportal endoscopic surgery methods. In contrast, minor complications were less common in the biportal group.

Recent Updates on Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

A number of minimally invasive spine surgeries (MISSs) have been developed to address the drawbacks of open spine surgery. Their advantages include small skin incisions, reduction in tissue damage, quick recovery, and short hospital stay. However, the clinical outcomes are comparable to open surgery. There was a cap on the number of indications that could be set for all spinal illnesses. The indications for MISSs have been expanding owing to mechanical and technological advances in medical equipment. Thus, this review presents the various MISSs developed to date, surgical indications, surgical techniques, and their advantages and disadvantages.