title: Unrecognized durotomy after lumbar discectomy: a report of four cases associated with the use of ADCON-L.
abstract: METHODS
  This report describes four cases of symptomatic cerebral spinal fluid leak after lumbar microdiscectomy where ADCON-L was used.
  
  
  OBJECTIVE
  To report that ADCON-L may exacerbate cerebral spinal fluid leak from unrecognized, small dural tears after lumbar discectomy.
  
  
  BACKGROUND
  ADCON-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.
  
  
  CONCLUSIONS
  ADCON-L may inhibit dural healing and exacerbate cerebral spinal fluid leak from microscopic durotomies not recognized at the time of surgery.
authors.affiliation: Spine Institute at Saint John's Health Center, Santa Monica, CA, USA.
authors.forename: A X
authors.initials: AX
authors.lastname: Le
authors.forename: D E
authors.initials: DE
authors.lastname: Rogers
authors.forename: E G
authors.initials: EG
authors.lastname: Dawson
authors.forename: M A
authors.initials: MA
authors.lastname: Kropf
authors.forename: D A
authors.initials: DA
authors.lastname: De Grange
authors.forename: R B
authors.initials: RB
authors.lastname: Delamarter
mesh_terms: D000328:Adult; D002555:Cerebrospinal Fluid; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods; D004388:Dura Mater / Q000293:injuries*; D005782:Gels / Q000009:adverse effects*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009930:Organic Chemicals; D014057:Tomography, X-Ray Computed
chemical_list: C104199:ADCON-L; D005782:Gels; D009930:Organic Chemicals