injury occurs when the sac of tissue covering
the spinal cord, called the dura mater, tears
during surgery. It can cause patients' spinal
fluid to leak, leaving them with severe spinal
headaches and an increased risk of infection.
There's not a single best way to prevent
these tears — most of it comes down to the
operation itself and the surgeon's technique.
Having good lighting and clear visualization,
though, can minimize the risk. If a tear does
occur during the operation, repairing it right
then and there is crucial. The most common
way to augment the repair of these leaks is
to use a tissue sealant. New synthetic hydro-
gel sealants made for spinal surgeries are
phasing out fibrin-based sealants since they
provide watertight seals, don't need to be
thawed and set in a few seconds.
However, for sealants to work properly, the
patient must be kept in a certain position for
an extended amount of time post-operatively
— typically flat on their back, overnight.
Because of this, your facility should have
access to a hospital and have a solid transfer
plan in place for patients with dural tears.
Stand-alone ambulatory surgery centers with
23-hour programs also work well for these
cases.
Sometimes, the tear isn't caught and
repaired during the surgery. Be sure patients
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