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1 Chinese Journal of Tissue Engineering Research August 20, 2015 Vol.19, No.34 ( ) (XYDCX ) % 12 () h 48 h 812 d 9.5 d d :R318 :B : (2015) [J] (34): doi: /j.issn Biomaterial repair combined with continuous lumbar subarachnoid drainage for management of cerebrospinal fluid leakage and meningitis after spinal surgery Zhou Gang, Zhang Yu-kun, Huang Wei-min, Wang Cheng-wei (Department of Spine Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi , Xinjiang Uygur Autonomous Region, China) Abstract BACKGROUND: Traumatic or iatrogenic dural defects can cause persistent cerebrospinal fluid leakage, even progressing to life-threatening purulent meningitis. In patients with meningitis combined with cerebrospinal fluid leakage, most antibiotics are unable to enter the cerebrospinal fluid, as the cerebrospinal fluid is a good medium for bacteria and there is the presence of blood-brain barrier. So meningitis presents with acute onset, rapid development and infection difficult to control. OBJECTIVE: To evaluate the outcome of continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics for postoperative cerebrospinal fluid leakage combined with meningitis after biomaterial repair of dural defects. METHODS: A retrospective study was carried out to review the 12 cases of cerebrospinal fluid leakage combined with meningitis among 126 of cases who developed cerebrospinal fluid leakage (5.56%) undergoing spinal Zhou Gang, Attending physician, Department of Spine Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi , Xinjiang Uygur Autonomous Region, China Corresponding author: Huang Wei-min, Department of Spine Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi , Xinjiang Uygur Autonomous Region, China Accepted: ISSN CN /R CODEN: ZLKHAH 5513

2 . surgery from June 2008 to June During the operation, dural defects were directly sutured or repaired with autologous fascial sheet. All cases underwent thorough debridement and intravenous injection of sensitive antibiotics followed by continuous lumbar drainage and intrathecal administration of sensitive antibiotics (usually vancomycin), and then the incision was closed at stage I. RESULTS AND CONCLUSION: The cerebrospinal fluid leakage was found in the 12 cases at 2472 hours after surgery, averagely 48 hours; the infection was found at 812 days days after surgery, averagely 9.5 days. Headache and fever were significantly relieved at the 2nd day of intrathecal administration of antibiotics, and intracranial infection disappeared at 714 days after continuous lumbar drainage. Biochemical test of the cerebrospinal fluid and routine examination were done thrice, and the results were all normal. No bacterial growth was found in bacterial culture test, and the drainage tube was removed. There was no intraspinal infection, intracranial hypotension headache and hernia caused by the drainage tube. These findings indicate that autologous fascia repair combined with continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics is an effective method in the treatment of cerebrospinal fluid leakage with meningitis. Subject headings: Spine; Surgical Procedures, Operative; Intraoperative Complications; Subdural Effusion Funding: the Scientific Innovation Fund of Xinjiang Medical University, No. XYDCX Zhou G, Zhang YK, Huang WM, Wang CW. Biomaterial repair combined with continuous lumbar subarachnoid drainage for management of cerebrospinal fluid leakage and meningitis after spinal surgery. Zhongguo Zuzhi Gongcheng Yanjiu. 2015;19(34): Introduction 0.6%7.4% 2.31%9.37% [1-4] [5] % [6] % % [7-9] [10-12] (DuraSeal) (BioGlue)2 (EVICEL) [13-15] (DuraGide) () [16-17] [18-19] Subjects and methods % P.O. Box 10002, Shenyang

3 . > L 1 < 2.25 mmol/l< 120 mmol/l> 0.45 g/l > L mg 5 ml2 h 2/d ml/d 12 2Results h 48 h 812 d 9.5 d 3 10 ( ) d 16 d d 9.3 d d d 24.5 d ( com.cn) 3 ( ) %14.7% 5.56% [26] EC [27] 5-0 [28] () PLGA 6 PLGA ISSN CN /R CODEN: ZLKHAH 5515

4 . 1 Table 1 Comparative results of the present study and other relevant literature [20] [21] d 68 (P < 0.05) [22] d [23] [24] d [25] d 9 [26] 30 A 15 EC A () B (P < 0.05) B 15 [27] ( % )12 () % d 3Discussion [29-30] 12 13%32% [31] [32-33] [34] P.O. Box 10002, Shenyang

5 . () 4 References [1],. [J].,2009,6(7): [2] Davis RA.A long-term outcome analysis of 984 surgically treated herniated lumbar discs.neurosurg. 1994;80(3): [3] Waisman M, Schweppe Y.Postoperative cerebrospinal fluid leakage after lumbar spine operations. Conservative treatment.spine (Phila Pa 1976). 1991;16(1): [4] Hughes SA, Ozgur BM, German M, et al.prolonged Jackson-Pratt drainage in the management of lumbar cerebrospinal fluid leaks.surg Neurol. 2006; 65(4): , discussion [5],,,.[J].,2009,19(2): [6],.37[J].,2012,33(5): [7] Dafford EE, Anderson PA.Comparison of dural repair techniques.spine J. 2015;15(5): [8] Ghobrial GM, Maulucci CM, Viereck MJ,et al.suture Choice in Lumbar Dural Closure Contributes to Variation in Leak Pressures: Experimental Model.J Spinal Disord Tech Sep 8. [Epub ahead of print] [9] Cain JE Jr, Rosenthal HG, Broom MJ, et al.quantification of leakage pressures after durotomy repairs in the canine.spine (Phila Pa 1976). 1990;15(9): [10] Yu F, Wu F, Zhou R,et al.current developments in dural repair: a focused review on new methods and materials.front Biosci (Landmark Ed). 2013;18: [11] Sekhar LN, Mai JC.Dural repair after craniotomy and the use of dural substitutes and dural sealants.world Neurosurg. 2013; 79(3-4): [12] Epstein NE.Dural repair with four spinal sealants: focused review of the manufacturers' inserts and the current literature. Spine J. 2010; 10(12): [13] Jankowitz BT, Atteberry DS, Gerszten PC, et al.effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J. 2009; 18(8): [14] Epstein NE.Dural repair with four spinal sealants: focused review of the manufacturers' inserts and the current literature. Spine J. 2010; 10(12): [15] Miscusi M, Polli FM, Forcato S, et al.the use of surgical sealants in the repair of dural tears during non-instrumented spinal surgery.eur Spine J. 2014;23(8): [16] Hida K, Yamaguchi S, Seki T,et al.nonsuture dural repair using polyglycolic acid mesh and fibrin glue: clinical application to spinal surgery.surg Neurol. 2006; 65(2): ; discussion [17] Shimada Y, Hongo M, Miyakoshi N, et al.dural substitute with polyglycolic acid mesh and fibrin glue for dural repair: technical note and preliminary results.j Orthop Sci. 2006; 11(5): [18] Kitchel SH, Eismont FJ, Green BA.Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine.j Bone Joint Surg Am. 1989;71(7): [19] Guerin P, El Fegoun AB, Obeid I, et al.incidental durotomy during spine surgery: incidence, management and complications. A retrospective review.injury. 2012; 43(4): [20],,,. [J].,2015,31(1): [21].[J].,2015, (11): [22].[J].,2014,(20): [23],,.41[J].,2014,(2): [24],,,. [J].,2014,12(5): [25],,,.29 [J].,2014,43(15): [26],,,. [J].,2013,6(12): [27],,. [J].,2013,18(48): [28].PLGA [D] [29] Eldrige JS,Weingarten TN,Rho RH. Management of cerebral spinal fluid leak complicating spinal cord stimulator implantation. Pain Pract. 2006;6(4): [30] Maher CO, Meyer FB, Mokri B.Surgical treatment of spontaneous spinal cerebrospinal fluid leaks.neurosurg Focus. 2000; 9(1):e7. [31]. [J].,2009,24(5): [32] Glassman SD, Dimar JR, Puno RM,et al.salvage of instrumental lumbar fusions complicated by surgical wound infection.spine (Phila Pa 1976). 1996;21(18): [33] Mehbod AA, Ogilvie JW, Pinto MR, et al.postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure.j Spinal Disord Tech. 2005; 18(1): [34] Richards BS.Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis.j Bone Joint Surg Am. 1995;77(4): ISSN CN /R CODEN: ZLKHAH 5517