Korean J Spine.  2016 Jun;13(2):87-90. 10.14245/kjs.2016.13.2.87.

Repair of Inaccessible Ventral Dural Defect in Thoracic Spine: Double Layered Duraplasty

• Lee DH
• Kim KT
• Park JI
• Park KS
• Cho DC
• Sung JK

• KMID: 2328340
• DOI: http://doi.org/10.14245/kjs.2016.13.2.87

Abstract

We propose a double layered (intradural and epidural patch) duraplasty that utilizes Lyoplant and Duraseal. We examined a 47-year-old woman after decompression for thoracic ossification of posterior longitudinal ligament was performed in another hospital. On postoperative day 7, she complained of weakness in both legs. Postoperative magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) collection with cord compression. In the operative field, we found 2 large dural defects on the ventral dura mater. We performed a conventional fat graft with fibrin glue. However, the patient exhibited neurologic deterioration, and a postoperative MRI again showed CSF collection. We performed dorsal midline durotomy and inserted a intradural and epidural Lyoplant patch. She immediately experienced diminishing back pain postoperatively. Her visual analog scale and motor power improved markedly. Postoperative MRIs performed at 2 and 16 months showed no spinal cord compression or CSF leakage to the epidural space. We describe a new technique for double layered duraplasty. Although we do not recommend this technique for all dural repairs, double-layered duraplasty may be useful for repairing large inaccessible dural tears in cases of persistent CSF leakage refractory to conventional management.

Keyword

Dura mater; Repair; Microtomy; Cerebrospinal fluid leak

MeSH Terms

Back Pain
Cerebrospinal Fluid
Cerebrospinal Fluid Leak
Decompression
Dura Mater
Epidural Space
Female
Fibrin Tissue Adhesive
Humans
Leg
Magnetic Resonance Imaging
Microtomy
Middle Aged
Ossification of Posterior Longitudinal Ligament
Spinal Cord Compression
Spine*
Tears
Transplants
Visual Analog Scale
Fibrin Tissue Adhesive