PMID- 34889999
OWN - NLM
STAT- MEDLINE
DCOM- 20220406
LR  - 20220429
IS  - 1432-0932 (Electronic)
IS  - 0940-6719 (Linking)
VI  - 31
IP  - 3
DP  - 2022 Mar
TI  - Dural tear repair surgery comparative analysis: a stitch in time saves nine.
PG  - 575-595
LID - 10.1007/s00586-021-07081-y [doi]
AB  - PURPOSE: A dural tear is a common iatrogenic complication of spinal surgery 
      associated with a several post-operative adverse events. Despite their common 
      occurrence, guidelines on how best to repair the defect remain unclear. This 
      study uses five post-operative outcomes to the compare repair methods used to 
      treat 106 dural tears to determine which method is clinically favourable. 
      METHODS: Data were retrospectively collected from Southampton General Hospital's 
      online databases. 106 tears were identified and grouped per repair method. MANOVA 
      was used to compare the following five outcomes: Length of stay, numbers of 
      further admissions or revision surgeries, length of additional admissions, 
      post-operative infection rate and dural tear associated neurological symptoms. 
      Sub-analysis was conducted on patient demographics, primary vs non-primary 
      closure and type of patch. Minimal clinically important difference (MCID) was 
      calculated via the Delphi procedure. RESULTS: Age had a significant impact on 
      patient outcomes and BMI displayed positive correlation with three-fifth of the 
      predefined outcome measures. No significant difference was observed between 
      repair groups; however, primary closure +/- a patch achieved an MCID percentage 
      improvement with regards to length of original stay, rate of additional 
      admissions/surgeries and post-operative infection rate. Artificial over 
      autologous patches resulted in shorter hospital stays, fewer readmissions, 
      infections and neurological symptoms. CONCLUSION: This study reports primary 
      closure +/- dural patch as the most efficient repair method with regards to the 
      five reported outcomes. This study provides limited evidence in favour of 
      artificial over autologous patches and recommends that dural patches be used in 
      conjunction with primary closure. LEVEL OF EVIDENCE I: Diagnostic: individual 
      cross-sectional studies with consistently applied reference standard and 
      blinding.
CI  - (c) 2021. The Author(s).
FAU - Taylor, Charles
AU  - Taylor C
AUID- ORCID: 0000-0002-1386-5244
AD  - Faculty of Medicine, University of Southampton, Southampton General Hospital, 
      Southampton, UK. ct1g17@soton.ac.uk.
FAU - Khan, Amad
AU  - Khan A
AD  - Department of Neurosurgery, Southampton General Hospital, Southampton, UK.
FAU - Shenouda, Emad
AU  - Shenouda E
AD  - Department of Neurosurgery, Southampton General Hospital, Southampton, UK.
FAU - Brooke, Nicholas
AU  - Brooke N
AD  - Department of Neurosurgery, Southampton General Hospital, Southampton, UK.
FAU - Nader-Sepahi, Ali
AU  - Nader-Sepahi A
AD  - Department of Neurosurgery, Southampton General Hospital, Southampton, UK.
LA  - eng
PT  - Journal Article
DEP - 20211210
PL  - Germany
TA  - Eur Spine J
JT  - European spine journal : official publication of the European Spine Society, the 
      European Spinal Deformity Society, and the European Section of the Cervical Spine 
      Research Society
JID - 9301980
SB  - IM
MH  - Cross-Sectional Studies
MH  - *Dura Mater/surgery
MH  - Humans
MH  - *Neurosurgical Procedures/adverse effects
MH  - Reoperation
MH  - Retrospective Studies
OTO - NOTNLM
OT  - *Dural patch
OT  - *Dural tear
OT  - *Incidental durotomy
OT  - *Primary closure
EDAT- 2021/12/11 06:00
MHDA- 2022/04/07 06:00
CRDT- 2021/12/10 12:26
PHST- 2021/07/06 00:00 [received]
PHST- 2021/11/29 00:00 [accepted]
PHST- 2021/10/14 00:00 [revised]
PHST- 2021/12/11 06:00 [pubmed]
PHST- 2022/04/07 06:00 [medline]
PHST- 2021/12/10 12:26 [entrez]
AID - 10.1007/s00586-021-07081-y [pii]
AID - 10.1007/s00586-021-07081-y [doi]
PST - ppublish
SO  - Eur Spine J. 2022 Mar;31(3):575-595. doi: 10.1007/s00586-021-07081-y. Epub 2021 
      Dec 10.