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Case Reports in Orthopedics
Volume 2016, Article ID 4903143, 6 pages
Case Report

Preservation and Tissue Handling Technique on Iatrogenic Dural Tear with Herniated Nerve Root at Cauda Equina Level

1Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta 10320, Indonesia
2Neurophysiology Division, Neurology Department, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta 10320, Indonesia
3Stem Cell and Tissue Engineering Cluster, MERC Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Received 8 November 2016; Accepted 12 December 2016

Academic Editor: Eyal Itshayek

Copyright © 2016 Ahmad Jabir Rahyussalim et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Iatrogenic or incidental dural tear is a relatively common complication in lumbar decompression surgery. Although mostly there are no changes that occurred in long-term result following an incidental durotomy, the sequelae are not always benign especially when the herniated nerve root is involved. Preservation and tissue handling is paramount in order to prevent further injury. Two cases of dural tear with herniated nerve root complicating the lumbar decompression surgery are presented. Direct watertight repair was performed using the preservation and tissue handling concept. Assessing the relative size between the dural tear and the root mass is the key in determining whether enlargement of tear is needed. Whenever feasible, the tear will not be enlarged. Opening the vent by using a suture anchor and manually repositioning the nerve root with a fine instrument is the key for an atraumatic handling of the herniated nerve root. Clinical and neurophysiology examination was performed postoperatively and no further neurologic deficit occurred despite the iatrogenic injury. Although some debate on a few intraoperative and postoperative details still persists, tissue handling and preservation concept should be applied in all cases.