Clinical efficacy of intraoperative hemostatic gauze covering teared dura meter in the treatment of cerebrospinal fluid leakage during lumbar spine surgery

English Keywords:Posterior lumbar surgery  Cerebrospinal fluid leakage  Hemostatic sponge  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To observe the clinical effect of hemostatic sponge covering teared dura meter in the treatment of cerebrospinal fluid leakage during lumbar posterior decompression. Methods: From January 2014 to June 2016, clinical and operative records of 1896 patients undergoing spinal surgery in our institute were reviewed retrospectively. Among them, 86 cases of dural tear were found in the posterior decompression, including 35 males and 51 females with an average age of 53.8±8.3 years old, and all the dural tears were repaired. There were 46 patients in group A using hemostatic gauze with gelatin sponge covering pressure. 40 patients in group B using deep fascia covering dural sac combined with gelatin sponge covering pressure treatment. Gender, age, diagnosis, operation time, length of dural tear and intraoperative blood loss were collected. Incidence of cerebrospinal fluid leakage after surgery, drain output, drain duration, time of getting up and the early complications were collected. All patients with cerebrospinal fluid leakage were re-examined with lumbar MRI at the last follow-up to observe long-term complications and dural cyst, pseudocyst or cerebrospinal fluid sinus. Results: There was no significant difference between the experimental group and the control group in gender, age, diagnosis, the size of dural tear, operation time or intraoperative blood loss(P>0.05). The incidence of cerebrospinal fluid leakage in group A was 15.2%(7/46), which was lower than that in group B 35%(14/40), P＜0.05. The drainage tube indwelling time(3.5±1.3d) and the average daily cerebrospinal fluid drainage volume(125.0±59.3ml) in the experimental group were significantly lower than those in the control group(10.5±2.1d; 329.0±103.1ml), the differences were statistically significant(P＜0.05). Time of getting up for patients in the experimental group(7.5±1.6d) significantly earlier than that in the control group(14.5±2.2d), with statistically significant difference(P＜0.05); postoperative intracranial pressure headache(2/7), healing of incision leakage(0/7), wound infection(0/7) and other early complications of cerebrospinal fluid leakage were lower than those in the control group(8/14, 2/14, 1/14), P<0.05. The follow-up of patients after surgery in group A revealed no cerebrospinal fluid cyst or subcutaneous fistula formation, while in group B there was 1 case of epidural cerebrospinal fluid cyst, there was no subcutaneous CSFL sinus formation. Conclusions: The application of hemostatic sponge dura combined with gelatin sponge compression treatment for cerebrospinal fluid leakage in posterior lumbar decompression is effective. It can reduce the time of drainage, flow of cerebrospinal fluid leakage, the incidence of cerebrospinal fluid leakage after operation and the related early complications.