Outcomes of N-butyl cyanoacrylate use in cases where incidental durotomy developed in lumbar disc herniation surgery

Abstract

Aim: Incidental durotomy (ID) occurred during lumbar disc herniation surgery is one of the most frequently encountered surgical complications. Different methods have been defined related to the repair of durotomy during the perioperative period. The author explains the use and results of n-butyl cyanoacrylate (NBCA) which is one of the agents used for repair of ID. Material and Method: The records of cases that ID developed and that were operated due to lumbar disc herniation were retrospectively reviewed and their results were discussed. Totally 29 cases were operated using the described method. All durotomy defects were less than l cm. None of ID's were repaired with primary suturation. NBCA (Glubran 2 (R)) was conveyed to regions by the method of instillation and covered as a thin layer. Results: All cases were mobilized next morning after the surgery. The average time elapsed until the discharge is 2,8 days. Postoperative subcutaneous cerebrospinal fluid (CSF) collection development was detected in 1 case and treated with the conservative method. In 2 cases paresthesia which started in the early postoperative period and treated with pregabaline 50 mg for one month period. Discussion: NBCA is a fast and effective preventive preparation for cases where ID developed in lumbar disc herniation surgeries. It strongly sticks to the dura and doesn't break away or meltdown. NBCA allows early mobilization in the postoperative period and does not have any compressive effect on root if It covers the dural defect as a thin layer. If It is used appropriately, the results are very satisfactory.