Incidental durotomy during tubular microdiscectomy does not preclude same-day discharge
Eva Liu1, Sabahat Saeed1, Nicole R Coote1
1Division of Neurosurgery, Department of Surgery, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
Purpose:
One of the major advantages of a minimally invasive microdiscectomy is that when CSF leak occurs, there is minimal anatomic dead space for ongoing leakage following removal of the tubular retractor. However, there are no published reports that address the safety and long-term outcomes of same-day discharge for CSF leak after tubular microdiscectomy.
Methods:
This is a retrospective compartive study of 30 patients with incidental durotomy during minimally invasive tubular microdiscectomy occurring between January 1, 2009 to August 31, 2023 at our institution.
Results:
There were 16 patients (53%) admitted to hospital and 14 (47%) patients discharged home the same day following CSF leak. There were no differences in patient demographics between the two groups at baseline. Twenty-nine out of 30 (97%) of the patients had onlay duraplasty, and one (3%) patient was repaired using sutures through the tubular retractor. None were converted to an open approach. The hospitalized group was kept on bed rest overnight or for 24 h. The discharge group was kept on best rest for 2 h or mobilized immediately after surgery. No patients in either group required readmission or revision surgery for CSF leak. The average length of admission for the hospitalized group was 2.4 ± 4.0 days.
Conclusion:
Patients with CSF leak during minimally invasive tubular microdiscectomy can be safely discharged home the same day.
Insights
Patients undergoing minimally invasive microdiscectomy with cerebrospinal fluid (CSF) leaks can be safely discharged home the same day. This approach minimizes complications and avoids prolonged hospital stays for CSF leak management.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Minimally Invasive Procedures
Background:
- Minimally invasive microdiscectomy offers advantages, including reduced dead space for cerebrospinal fluid (CSF) leaks.
- Limited data exists on same-day discharge outcomes for incidental durotomy after tubular microdiscectomy.
Purpose of the Study:
- To evaluate the safety and outcomes of same-day discharge for patients experiencing CSF leaks during minimally invasive tubular microdiscectomy.
- To compare same-day discharge with overnight hospitalization for incidental durotomy.
Main Methods:
- Retrospective comparative study of 30 patients with incidental durotomy during minimally invasive tubular microdiscectomy.
- Patients were divided into same-day discharge (n=14) and hospitalized (n=16) groups.
- Surgical repair involved onlay duraplasty (97%) or sutures (3%); no open conversions were needed.
Main Results:
- No significant demographic differences were observed between discharge and hospitalization groups.
- All patients (100%) had successful CSF leak repair without readmission or revision surgery.
- Hospitalized patients averaged 2.4 days of admission, while discharged patients had minimal bed rest.
Conclusions:
- Same-day discharge is a safe and effective strategy for managing incidental durotomy after minimally invasive tubular microdiscectomy.
- This approach can reduce hospital length of stay without compromising patient outcomes.
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