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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Dural Membrane of the Spine



- Discussion:
    - spinal dura is separated from inner surface of bones forming vertebral canal by epidural space containing fat and a rich plexus of veins;
    - dural sac continues inferiorly to about middle of 2nd sacral vertebra;
    - pia mater:
            - closely attached to spinal cord, & subarachnoid space;
            - contains CSF;
            - is the space between cord & arachnoid;
    - subarachnoid space:
            - is prolonged in a duralarachnoid sheath around each dorsal and ventral root, roughly to level of union of roots;
    - below inferior end of the cord, the duralarachnoid sac contains leash of nerve roots and the filum terminale;

- Dural Tear:
    - dural tears that occur during spine surgery may be followed by development of duralcutaneous fistula & result in meningitis, or 
           pseudomeningocele may form and produce symptoms of pressure or entrap nerve rootlets;
    - dural tear that is discovered intraoperatively is best treated by direct repair, a fascial graft, or both;
    - pt is kept recumbent for 1-5 days postoperatively;
    - pseudomenigcele:
           - may follow attempted dural repair;
           - look for orthostatic headaches and/or subcutaneous fluid mass;
           - CT myelogram is the study of choice to delineate this lesion



Organization of intrathecal nerve roots at the level of the conus medullaris.

Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine.

Dural laceration occurring with burst fractures and associated laminar fractures.

Treatment of dural tears associated with spinal surgery.

Postoperative cerebrospinal-fluid fistula associated with erosion of the dura. Findings after anterior resection of ossification of the posterior longitudinal ligament in the cervical spine.

Treatment of dural tears associated with spinal injury.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 25, 2012 12:06 pm