title: Incidence of Pinhole Type Durotomy and Subsequent Cerebrospinal Fluid Leakage Following Simple Laminectomy.
abstract: METHODS
  Cross sectional study.
  
  
  OBJECTIVE
  The purpose of this study was to determine the incidence and the associated risk factors of pinhole type of durotomy and cerebrospinal fluid (CSF) leakage following a simple laminectomy for spinal stenosis.
  
  
  BACKGROUND
  The incidence of spinal stenosis is expected to rise with increasing life expectancy. Moreover, lumbar spinal stenosis is the most common indication for spinal injury in the geriatric population. It is therefore important to identify and prevent the risks associated with laminectomy, the most widely used surgical procedure for spinal stenosis. The serious complication of incidental dural tear or durotomy and subsequent CSF leakage has not been studied in the region of Southeast Asia.
  
  
  METHODS
  In this cross sectional study, we included 138 adult patients (age>18 years), who underwent a simple laminectomy for lumbar stenosis between 2011 and 2012. CSF leakage was the main outcome variable. Patients' wounds were examined for CSF leakage up to 1 week postoperatively.
  
  
  RESULTS
  The incidence of pinhole type durotomy and subsequent CSF leakage in our region was 8.7%. Univariate analysis showed that hypertension, diabetes and smoking were significantly associated with durotomy and increased CSF leakage by 16.72, 44.25, and 33.71 times, respectively. Multivariate analysis showed that only smoking and diabetes significantly increased the chances of leakage.
  
  
  CONCLUSIONS
  Glycemic control and cessation of smoking prior to a simple laminectomy procedure reduced the incidence of a dural tear. Larger clinical studies on this lethal complication are required.
authors.affiliation: Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Faizan Imran
authors.initials: FI
authors.lastname: Bawany
authors.affiliation: Neurosurgery Department, Civil Hospital, Karachi, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Emaduddin
authors.affiliation: Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Manzar
authors.initials: M
authors.lastname: Shahid
authors.affiliation: Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Mehwish
authors.initials: M
authors.lastname: Hussain
authors.affiliation: Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Yousuful Islam
authors.affiliation: Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Muhammad Shahzeb
authors.initials: MS
authors.lastname: Khan
keywords: Cerebrospinal fluid leak; Dura mater; Incidence; Laminectomy; Risk factors