Analysis of position and intra-post-operative measures of dural tear in elderly patients with lumbar spinal stenosis

Objective To assess the anatomical mechanism,position,and surgical treatment of dural tear in elderly patients with lumbar spinal stenosis. Methods From January 2012 to January 2014,a total of 216 patients older than 70 years who underwent posterior lumbar interbody fusion due to lumbar spinal stenosis were retrospectively analyzed. The perioperative data were recorded as general information,duration of the symptom,preoperative diagnosis,surgical procedures,position of dural tear and intraoperative treatment,postoperative cerebrospinal fluid leakage and treatment,and complications.Results Intraoperative dural tear occurred in 34 patients of 151 enrolled patients,23 patients with postoperative cerebrospinal fluid leakage. The comparison of the incidence of dural tear position was posterior-lateral side of dural sac root sleeve lateral side of dural sac ventral side of dural sac. All the torn dural sac were treated with dural sac suture,gelatin sponge oppression,or fibrin glue adhesion. A Combining the methods of tight suture closure of fascia and delayed extubation,all the cerebrospinal fluid leakage stopped 3-10 d postoperatively,and no severe complications were observed. Conclusion The incidence of dural tear in elderly patients over 70 years old was higher than the overall population. The majority of the dural tear occurred in the position of posterolateral dural sac and root sleeve. Tight suture closure of fascia and delayed extubation could be helpful in the treatment of postoperative cerebrospinal fluid leakage.