title: Ventral Dural Injury After Oblique Lumbar Interbody Fusion.
abstract: BACKGROUND
  Oblique lumbar interbody fusion (OLIF) through the oblique corridor between the aorta and anterior border of psoas muscle is favored among spinal surgeons who employ minimally invasive techniques. We report a case of ventral dural tear after OLIF that was associated with the inaccurate trajectory direction of endplate preparation. This is the first report to our knowledge of ventral dural tear associated with OLIF.
  
  
  METHODS
  A 72-year-old woman presented with right leg pain and numbness. X-rays showed degenerative spondylolisthesis and loss of disc height at L4-L5 and L5-S1 levels. Magnetic resonance imaging revealed right-sided paracentral disc herniation at the L3-L4 level and foraminal disc herniation at L4-L5. The initial surgical plan was OLIF of L3-L4 and L4-L5 after percutaneous screw fixation without laminectomy. With the patient in the lateral position, discectomy and endplate preparation were done successfully at the L3-L4 level, and the same procedure was done at the L4-L5 level for OLIF. A sharp Cobbs elevator for endplate preparation triggered a ventral dural defect at the L4-L5 level. We changed the patient's position to attempt dural repair. The ventral dural defect could not be repaired because it was too large. After the herniated rootlets were repositioned, TachoComb was patched over the defect site. Postoperatively, the patient has no definite neurologic deficits.
  
  
  CONCLUSIONS
  When a surgeon performs OLIF, ventral dural injury should be avoided during the procedure of endplate preparation and contralateral annular release.
authors.affiliation: Department of Neurosurgery, Soon Chun Hyang University Hospital, Seoul, Korea.
authors.forename: JaeChil
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. Electronic address: mddavidk@gmail.com.
authors.forename: Jin-Sung
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hyunjin
authors.initials: H
authors.lastname: Jo
mesh_terms: D000368:Aged; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D013123:Spinal Fusion / Q000009:adverse effects*; D013168:Spondylolisthesis / Q000601:surgery; D014056:Tomography, X-Ray; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology*
keywords: Complication; OLIF; Ventral dural injury