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04-OCTOBER-2018 SODA IYADEH AL-RWELY 59 YEARS
PERSISTENT WOUND LEAK AFTER DECOMPRESSIVE LAMINECTOMY L4-5.
Anamnesis
The patient was operated by me
30-September-2018
for lumbar canal stenosis L4-5 and decompressive
laminectomy of L4 and upper half of L5 with
foraminotomy both L5 roots was performed. During
the operation, the dura was very thin due to
severe compression, but no apparent tear, nor
CSF leaking points. The
patient is diabetic and usually we keep them for
2 days after surgery until the wound is dry.
Here the wound still oozing, holding suspicion
of CSF leak from the very thin dura, for what
revision of the wound was taken in
consideration.
The wound was opened. There is
CSF in the field. Inspection of the areas, showed
that there is no proper dural defect, instead there
is oozing from the are below the axilla of the right
L5 root. Despite the fact, that there is no tear 6
zero nylon was applied over the area to plicate dura
and make it more strong. The patient
was put in anti-Reverse Trendelenburg position with Valsalva
maneuver. No CSF leak. A piece of muscle was
harvested and put to that angle and Surgicele was
applied over it. Routine water-tight closure of the wound.
Smooth postoperative recovery. She was sent to the ward.
Comments
The patients with diabetes mellitus are
full of surprises and this case is one of them.
During the first surgery the dura was
very thin due to severe compression, but no CSF came out. We
did not perform anti-Reverse Trendelenburg position and Valsalva
maneuver during the surgery, which routinely performing it.
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