Use of Subfascial Passive Bile Bag Drainage for the Management of Durotomies in Spine Surgery.
| Autor: | Bauerle L; College of Medicine, Medical University of South Carolina, Charleston, USA., Wessell JE; Department of Neurosurgery, Neurosurgical and Spine Institute of Savannah, Savannah, USA., Bindner S; College of Medicine, Medical University of South Carolina, Charleston, USA., Saway BF; Department of Neurosurgery, Medical University of South Carolina, Charleston, USA., Wolgamott L; Department of Neurosurgery, Stanford Health Care, Palo Alto, USA., Kalhorn SP; Department of Neurosurgery, Medical University of South Carolina, Charleston, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2024 Sep 01; Vol. 16 (9), pp. e68397. Date of Electronic Publication: 2024 Sep 01 (Print Publication: 2024). |
| DOI: | 10.7759/cureus.68397 |
| Abstrakt: | Introduction: Historically, the use of subfascial drains for the management of durotomies was avoided due to concerns about the creation of cerebrospinal fluid (CSF) fistulas. Currently, there are limited series utilizing subfascial drainage for CSF leak management, many of which utilize suction drainage. We report our experience with the use of subfascial passive drainage in the management of such leaks. Objective: To demonstrate the efficacy of a passive subfascial bile bag for diversion of CSF post-operatively in concert with a post-operative head of bed (HOB) protocol for the management of durotomies in spine surgery. Methods: We performed a retrospective chart review of patients who underwent spinal surgery at a single institution performed by one surgeon. Cases utilizing a passive subfascial bile bag for durotomies were identified. A total of 1,882 consecutive surgeries were reviewed, and 108 met the inclusion criteria. The primary outcome was return to the operating room (OR) and/or the need for lumbar drain placement. Patient sociodemographic information and pre-, intra-, and post-operative clinical characteristics were reviewed. Results: A total of 108 patients underwent subfascial bile bag CSF diversion after intra-operative durotomy. Four patients (3.7%) experienced post-operative CSF leakage requiring lumbar drain placement, while only two (1.9%) patients required a return to the OR. One patient returned to the OR for symptomatic pseudomeningocele and the other for ongoing CSF drainage from their wound. Conclusion: Durotomies are known to increase complication rates, including reoperation. The use of subfascial passive bile bag drainage in concert with a post-operative HOB protocol is a safe and effective manner to manage durotomies while minimizing the need for reoperation. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Medical University of South Carolina’s Institutional Review Board issued approval Pro00113249. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Stephen P. Kalhorn declare(s) royalties from Medical University of South Carolina (MUSC) Zucker Institute. Royalty payments received on devices licensed through the MUSC Zucker Institute. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Bauerle et al.) |
| Databáze: | MEDLINE |
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