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Pedicled Multifidus Muscle Flap To Treat Inaccessible Dural Tear In Spine Surgery: Technical Note And Preliminary
Domenico Policicchio1, Riccardo Boccaletti1, Giosuè Dipellegrini1
1Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy.
Objective:
To assess the usefulness, feasibility, and limitations of pedicled multifidus muscle flaps (PMMFs) for the treatment of inaccessible dural tears during spine surgery.
Methods:
The technique of PMMF harvesting was investigated together with relevant anatomy. We prospectively evaluated 8 patients treated with the PMMF technique between January 2017 and December 2019. Results were compared with a retrospective series of 9 patients treated with a standard technique between January 2014 and December 2016. Inclusion criteria were inaccessible dural tear or dural tear judged not amenable to direct repair because of tissue loosening. Exclusion criteria were surgical treatment of intradural disease. Clinical and demographic data of all patients were collected. Clinical evaluations were performed according to American Spinal Injury Association criteria and Oswestry Disability Index. Preoperative and postoperative computed tomography was performed in all patients. The primary end point was wound healing (cerebrospinal fluid leakage, infection, and fluid collection); secondary end points were neurologic outcome and complications.
Results:
Control group: 1 death as a result of wound infection secondary to cerebrospinal fluid fistula and 2 patients needed lumbar subarachnoid drain; neurologic outcome: 3 patients improved and 6 were unchanged. Flap group: no wound-related complications were observed; neurologic outcome: 3 patients improved and 5 were unchanged. No flap-related complications were described. Flap harvesting was feasible in all cases, with an average 20 minutes adjunctive surgical time.
Conclusions:
The PMMF technique was feasible and safe; in this preliminary experience, its use is associated with lower complications as a result of dural tears but larger series are needed to confirm its effectiveness.
Insights
Pedicled multifidus muscle flaps (PMMFs) offer a feasible and safe technique for treating inaccessible dural tears in spine surgery. This method showed reduced complications compared to standard techniques, though further research is needed.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Surgical Techniques
Background:
- Dural tears during spine surgery can be challenging to manage, especially when inaccessible or associated with tissue loosening.
- Standard repair techniques may have limitations in complex cases, potentially leading to complications like cerebrospinal fluid leakage and infection.
Purpose of the Study:
- To evaluate the effectiveness, feasibility, and safety of pedicled multifidus muscle flaps (PMMFs) for treating inaccessible dural tears.
- To compare outcomes of PMMF technique with standard dural repair methods.
Main Methods:
- Prospective evaluation of 8 patients undergoing PMMF for dural tears (2017-2019).
- Comparison with a retrospective cohort of 9 patients treated with standard techniques (2014-2016).
- Assessment of wound healing, neurological outcomes (ASIA criteria, Oswestry Disability Index), and complications via clinical evaluation and CT scans.
Main Results:
- The PMMF group experienced no wound-related complications, whereas the control group had one death from infection and two required drains.
- Neurological outcomes were similar between groups, with improvement in 3 patients and no change in 6 in the control group, and improvement in 3 and no change in 5 in the PMMF group.
- PMMF harvesting was feasible in all patients, adding an average of 20 minutes to surgical time with no flap-related complications.
Conclusions:
- The pedicled multifidus muscle flap (PMMF) technique is a feasible and safe option for managing inaccessible dural tears.
- Preliminary results suggest PMMFs are associated with fewer complications than standard techniques.
- Larger studies are required to definitively establish the efficacy of PMMFs in spine surgery.
