Unrecognized durotomy after lumbar discectomy -: A report of four cases associated with the use of ADCON®-L

Study Design. This report describes four cases of symptomatic cerebral spinal fluid leak after lumbar microdiscectomy where ADCON(R)-L was used. Objectives. To report that ADCON(R)-L may exacerbate cerebral spinal fluid leak from unrecognized, small dural tears after lumbar discectomy. Summary of Background Data. ADCON(R)-L is a porcine-derived polyglycan that is used with increasing frequency in spinal surgery. It is advocated to reduce postoperative peridural fibrosis and adhesions. Methods. Four cases of symptomatic cerebral spinal fluid leak after lumbar microdiscectomy were identified. Information on these patients was obtained by chart review. Results. Three patients had small, inadvertent durotomies that were not appreciated at surgery even with the aid of a microscope. The dural violation in the fourth patient occurred at the previous epidural steroid injection site located on the contralateral side of the laminotomy. Conclusion. ADCON(R)-L may inhibit dural healing and exacerbate cerebral spinal fluid leak from microscopic durotomies not recognized at the time of surgery.