Purpose: Postoperative management of incidental durotomy in spinal operations is not standardized; evidence-based standardization with particular regard to mobility status is overdue. The aim of this study was to assess the incidence of dural tears and the outcomes of different postoperative mobilization protocols with regards to cerebrospinal fluid leak rate.
Methods: A retrospective analysis of all spinal surgery over a four-year period at one institution. A review of operation, and case notes to assess the intra- and post-operative management of patients suffering a dural tear and their outcomes.
Results: 3361 patients underwent invasive spinal intervention over four years. The age range was 17 to 94. The dural tear rate was higher in lumbar surgery (7.8%) compared with cervical (1.4%) and thoracic (3.8%); (p=0.000) and also in revision surgery (13.5%) compared with primary (4.8%) (p=0.000). When looking at all dural tears there was no significant difference in outcome between varying methods of dural repair and no repair at all (p=0.790). The persistent leak rate was higher in those kept in bed (17.2%) compared to those mobilised immediately (10.5%), this wasn’t statistically significant (p=0.320). Tears occurred in 42 lumbar microdiscectomies; 93% were mobilised immediately and 79% had no dural repair, one patient developed a persistent leak. There was no difference between different repairs (p=0.964) and mobilization regimes (p=0.929). In patients undergoing bony lumbar decompression, there was a difference between suture repair of the dura (9.5%) and non-suture (18%), this was not significant (p=0.304).
Conclusions: We advocate that patients who suffer an intra-operative dural tear should be mobilised immediately. In minimally invasive surgery such as microdiscectomy a watertight layered closure is sufficient, however, tears occurring during more invasive decompression procedures should all undergo a primary suture repair.
Incidental spinal durotomy, Spinal surgery, Complication rates