Negative pressure wound therapy in cases of spinal surgery and exposed dura: a case-based review

Abstract

Purpose: Study of negative pressure wound therapy (NPWT) safety for patients with intraoperative exposure of the dura.

Methods: We analyzed the literature on the NPWT usage after spinal surgery in patients with exposure of the dura. We also described our experience of NPWT in 3 pediatric patients with spinal dysraphism. Due to the peculiarities of the anatomy (spina bifida), all of these patients had dural sac exposure during spinal surgery.

Results: The reasons for NPWT in all three cases were different. In the first patient with segmental spinal dysgenesis, surgery was complicated by extensive postoperative wound necrosis and the formation of soft tissue deficiency. The second patient with post-myelomeningocele kyphosis had a deficiency of soft tissues during spinal surgery due to a large bedsore at the apex of the deformity. And in the third patient also with post-myelomeningocele kyphosis, NPWT was applied with surgical site infection. In all three cases, NPWT was used when the dura was exposed, without complications and with satisfactory results. The observation period for the patients was 3 years, 2.5 years, and 2 years, respectively.

Conclusions: The usage of NPWT in cases of wound complications in the spinal surgery may be a useful option, which allows saving implants. NPWT is not contraindicated in cases of intraoperative dural exposure if there are no signs of cerebrospinal fluid (CSF) leak.

Keywords: Myelomeningocele; Negative pressure wound therapy; Spinal dysraphism; Vacuum-assisted closure.