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Case Reports
. 2011 Aug;3(3):188-92.
doi: 10.1111/j.1757-7861.2011.00135.x.

Simultaneous intra-operative repair for inadvertent dural tear under posterior lumbar disk scope

Ming-ju Sun  1 , Sai-ming Gao, Yan-hui Wang
Affiliations
Case Reports

Simultaneous intra-operative repair for inadvertent dural tear under posterior lumbar disk scope

Ming-ju Sun et al. Orthop Surg. 2011 Aug.

Abstract

Objective: To introduce a microsurgical suture technique for repair of dural tear under posterior lumbar disk scope.

Methods: Micro endoscopic discectomy was performed on a 26-year-old male under local anesthesia. During the operation, an irregular tear of about 1.0 cm was inadvertently made in the dura.The cauda equina herniated through the tear with fluctuations and leakage of cerebrospinal fluid. The tear was successfully sutured with a 7/0 microsurgical thread which was held by small disk forceps in a parallel position.

Results: Once the repair had been performed, minor cerebrospinal fluid leakage persisted but there was no herniation of the cauda equina. The original planned operation was completed smoothly under posterior lumbar disk scope.

Conclusion: The microsurgical suture technique for dural tear under posterior lumbar disk scope described here is simple and reliable.

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Figures

Figure 1
Figure 1
Approximately 1 cm dural tear.
Figure 2
Figure 2
A 7/0 microsurgical thread with two suture needles.
Figure 3
Figure 3
The needles were prebent with a small disk forceps.
Figure 4
Figure 4
The prebent needle was held by a small disk forceps with the plane of the curvature parallel with the teeth of the forceps and the needle tip facing proximally.
Figure 5
Figure 5
The disk forceps with needle was (a) inserted into the work tunnel to (b, c) first thread the contralateral side of the tear, and then (d) pulled out of the work tunnel.
Figure 6
Figure 6
The ipsilateral side of the tear was threaded.
Figure 7
Figure 7
(a) A single knot was made outside the portal and, (b, c) with both needle ends held by an assistant or retained by two vascular clamps, the surgeon, using the tip of a nerve hook, pushed the knot all the way down to the dura.
See this image and copyright information in PMC

References

    1. Shi CH, Wang YM, Dong JB, et al Treatment of 104 cases of lumbar disk herniation by microendoscopic discectomy (Chin). Zhonghua Wei Chuang Wai Ke Za Zhi, 2006, 6: 213–215.
    1. Qi Q, Bi ZG, Zhao CB, et al Comparative study of microsurgical lumbar discectomy and microendoscopic discectomy (Chin). Zhongguo Jiao Xing Wai Ke Za Zhi, 2006, 14: 328–330.
    1. Lu HL, Liu QX, Weng XS, et al Surgical treatment of lumbar intervertebral disc herniation by microendoscopic discectomy through posterior approach (Chin). Zhonghua Gu Ke Za Zhi, 2004, 24: 249–252.
    1. Zheng ZM. Several opinions on minimally invasive spinal surgery (Chin). Zhongguo Ji Zhu Ji Sui Za Zhi, 2004, 14: 85.

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