Efficacy Analysis Of Paraspinal Muscles Tight Suture Applying For Dural Tear In Posterior Spinal Surgery

Objective: To investigate the effect of the paraspinal muscle tight suture treating dural tear in posterior spinal surgery.Method: Selecting 41 cases consisting of 16 males and 25 females,suffered dural tear after the posterior surgery of thoracic vertebra and lumber vertebra from September,2013 to December, 2015 in our department. It will be divided into paraspinal muscles tight suture group in which paraspinal muscles was sutured twice by using absorbable No. 05 needles with 8-character-pattern sewing(stitch length1 cm, margins 1cm) and paraspinal muscle conventional suture(control group) in witch paraspinal muscles was sutured once by using absorbable No. 05 needles with 8-character-pattern sewing(stitch length1 cm, margins 1cm). Dural tear consiste of tearing accidentally and taking the initiative to cut the need as a result of the surgery. If the dural tear could be sutured,it can be gived diret suture with 6-0 absorbable suture, margins 1mm, stitch length 2-3mm.But we should pay attention to upper and lower ends of the suture lacerations to prevent cerebrospinal fluid from leaking break ends. Meantime autologous fasciatissue and the right amount of Gelfoam covered the lacerations.In addition to those who can not suture situation such as a breach is located in the ventral, anterolateral smaller or breach, irregular and so on.Due to dural repair materials such as fibrin glue is expensive and rarely applied in domestic, so we give patients from fascia tissue cover body, and then apply the right amount of gelatin sponge oppression. 38 of 41 cases give direct suture, 3 cases of application of autologous fascia tissue coverage.Postoperatively, two groups of cases were treated with conventional dressing change, rehydration, preventing infection and other treatment.Suture group and the control group, cerebrospinal fluid leakage stop time, number of intracranial hypotension symptoms after surgery, preoperative or postoperatie JOA, VAS score and the Axial area of Paraspinal muscle and dural sac between lacunar after postoperative5-7 days, were retrospectively analyzed.Results: 41 cases of patients, the suture group and the control group compared,suture group cerebrospinal fluid leakage stop time5.82±1.61 days significantly lower than control group 8.89±2.45 days;suture postoperative drainage 1251.52±218.31 ml significantly less than the control group 1725.83±303.04 ml; suture group were headache,nausea, or vomiting, low intracranial pressure symptoms in 2 patients less than 8 cases in the control group. Suture group with preoperative and postoperative JOA score and VAS scores was not statisticallydifferent comparing with the control group.Taking into accountthe the different of surgical site may affect the results of study, different surgical site we also did a comparison. But because of the smaller sample size of patients with thoracic surgery, so we have not done statistical analysis.Lumbar surgery patients, the suture group cerebrospinal fluid leakage stop time 5.95±1.82 days significantly lower than control group8.69±1.92 days; suture postoperative drainage 1277.00 ±208.37 ml significantly less than the control group 1707.19±265.82 ml; suture group were headache, nausea, or vomiting, low intracranial pressure symptoms in 2 patients less than 7 cases in the control group.Suture group with preoperative and postoperative JOA score and VAS scores was not statistically different comparing with the control group.Respectively comparing two groups of data,the suture group with the cerebrospinal fluid leakage stop time, postoperative drainage and appearring the number of cases of symptomatic intracranial pressure were lower than the control group, and there were statistically significant differences(P <0.05). And 9 cases after 5-7 days of review MRI showed suture group lacuna between paraspinal muscle and dural average axial area of 98.36±9.06mm2 also significantly lower than the control group440.58±60.76mm2.Conclusion: This study showed that the muscle sutured two layer and the fascia sutuered just one layer with 8-character-pattern sewingcould effectively reduce postoperative drainage, shorten the time stopping leakage of cerebrospinal fluid seeping and narrow the dead space between the dura and the paraspinal muscles, and contributed to dural tear treatment.