Asian Spine J.  2015 Aug;9(4):529-534. 10.4184/asj.2015.9.4.529.

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

• Bawany FI
• Emaduddin
• Shahid M
• Hussain M
• Yousuful Islam M
• Khan MS

• KMID: 2169322
• DOI: http://doi.org/10.4184/asj.2015.9.4.529

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.

Keyword

Cerebrospinal fluid leak; Dura mater; Incidence; Laminectomy; Risk factors

MeSH Terms

Adult
Asia, Southeastern
Cerebrospinal Fluid*
Constriction, Pathologic
Dura Mater
Humans
Hypertension
Incidence*
Laminectomy*
Life Expectancy
Multivariate Analysis
Risk Factors
Smoke
Smoking
Spinal Injuries
Spinal Stenosis
Wounds and Injuries
Smoke