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KMID : 1146020120050020063
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Journal of Critical Spine Cases
2012 Volume.5 No. 2 p.63 ~ p.67
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Posterior Transdural Dural Repair of Incidental Dural Tears in Anterior Lumbar Interbody Fusion: Report of Two Cases
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Cha Ki-Yong
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Abstract
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Anterior lumbar surgery has recently been considered as one of surgical options for lumbosacral spine disease. However, most neurosurgeons are not as familiar with this procedure as the conventional posterior approach and many of these surgeons have a little experience of anterior lumbar surgery. Under this circumstance, most reported complications concern injury to the vascular or visceral structures and both the risk of dural tear and neural damage during this procedure and the method of repair are rarely reported. We report two cases of transdural nerve root herniation caused by incidental dural tear during anterior lumbar interbody fusion. We also describe how these unexpected complications were managed; there were common radiological and surgical findings on the nerve root herniation through a dural defect during anterior lumbar discectomy. Both patients suffered from degenerative spondylolisthesis and foraminal stenosis with a redundant dural sac. In these patients, the dural tears occurred during anterior discectomy and the nerve roots subsequently herniated outward because of intradural pressure. The herniated neural tissues were restored via a posterior transdural approach. There is always the possibility of a dural tear with nerve root herniation during surgery employing an anterior lumbar approach. If this occurs, we should be aware of the difficulty in repairing the dura from this approach. We should also keep in mind that adequate repair of it is important to avoid related postoperative complication.
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KEYWORD
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Anterior lumbar surgery, Complications, Dural tear, Nerve root herniation
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