Current Trend of Treatment for Incidental Durotomy in Lumbar Spine Surgery in Thailand: National Survey

Abstract

Objective: To determine current decision making in treatment for incidental durotomy (ID) in Thailand.
Methods:A questionnaire was sent to all orthopedic surgeons who attended the annual meeting of the Spine Society of Thailand 2016. The questionnaire had 2 parts including demographic data and 15 questions about details of ID repairing technique and postoperative treatment. 
Results: Sixty-seven responses were received from 213 participants (31.45% response rate). All respondents were male and performed lumbar spine surgery. Twenty-seven (40.30%) respondents work in a regional hospital. When ID occurred, most of the respondents (87.93%) provided further treatment. Sixty-one percent of respondents preferred prolene. Nylon and silk were used in 20% and 15%, respectively. The preferred size of repairing material was 6-0 (52.23%) and 5-0 (28.36%). The interrupted suture was used in 68.65 percent (46/67). The augmentation included fat graft (29/58, 50%), fibrin glue (12/58, 20.69%) and spongiostan (9/58, 15.5%). Seventy-five percent of respondents (48/64) used vacuum drain and 80% of respondents (54/67) prescribed bed rest after every dural repair. The durations of bed rest were 24 hrs (14/66, 21.2%), 48 hrs (27/66, 40.9%), 72 hrs (16/66, 24.2%) and more than 72 hrs (9/66, 13.6%).
Conclusion:The perioperative management of lumbar ID in Thailand has substantial heterogeneity. Most of the participants prefer using interrupted suture, prolene, 6-0 in diameter, fat graft augmentation and placing wound drainage with vacuum. Duration of best rest varied between 24 to more than 72 hours.