Fistula Formation Between the Disc and Dura after Percutaneous Endoscopic Lumbar Discectomy: A Case Report
10.4184/jkss.2018.25.4.180
- Author:
Hak Sun KIM
1
;
Hyoung Bok KIM
;
Hoon Jae CHUNG
;
Jea Ho YANG
Author Information
1. Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
Percutaneous endoscopic lumbar discectomy;
Dural tear;
Fistula formation
- MeSH:
Adhesives;
Diagnosis;
Diskectomy;
Electromyography;
Fistula;
Humans;
Lower Extremity;
Magnetic Resonance Imaging;
Nylons;
Pain, Intractable;
Tears
- From:Journal of Korean Society of Spine Surgery
2018;25(4):180-184
- CountryRepublic of Korea
- Language:English
-
Abstract:
STUDY DESIGN: Case report OBJECTIVES: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). SUMMARY OF LITERATURE REVIEW: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. MATERIALS AND METHODS: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. RESULTS: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. CONCLUSIONS: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.
