|
Year |
2007 |
|---|---|
|
Question Number |
94 |
|
Category |
Spine |
Question
An incidental dural tear was primarily repaired with a watertight closure during an otherwise uncomplicated laminectomy. After surgery, the patient should be informed that
1- the chance of resolution of the preoperative symptoms will be decreased.
2- there is a greater risk of a wound infection.
3- the clinical outcome will be unaffected.
4- strict bed rest for 2 weeks is recommended.
5- a compression dressing must be maintained for 7 days.
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Answer (click for answer)
Answer: 3 – the clinical outcome will be unaffected
According to the cited articles, Wang et al found that a dural tear that occurs during an operation on the lumbar spine can be treated successfully with primary repair followed by bed rest. Postoperative management consisted of closed suction wound drainage for an average of 2.1 days and bed rest for an average of 2.9 days. Such a tear does not appear to have any long-term deleterious effects or to increase the risk of postoperative infection, neural damage, or arachnoiditis. Closed suction wound drainage does not seem to aggravate the leak and can be used safely in the presence of a dural repair. Eismont et al found that dural tears should be repaired at the time of the original operation either directly or utilizing a fascial graft or a tissue-plug technique. Therefore, answer 3 would be the best choice.
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