RESEARCH ARTICLE


Incidence and Management of Incidental Spinal Durotomies Noticed During Spinal Surgery



Ishvinder Singh Grewal1, Urpinder Singh Grewal2, *, Tom Eadsforth3, Christopher Barrett3, Robin Pillay3
1 Royal London Hospital, Barts Health NHS Trust Whitechapel Road, London,U.K.
2 Medway Maritime Hospital, Medway Foundation Trust Windmill Road, Gillingham, Kent, ME7 5NY,U.K.
3 The Walton Centre NHS Foundation Trust Lower Lane, Fazakerley, Liverpool, Merseyside L9 7LJ,U.K.


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© 2019 Grewal et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this auther at the Medway Maritime Hospital, Medway Foundation Trust Windmill Road, Gillingham, Kent, ME7 5NY; Tel: +447988507440; E-mail: urpinder.grewal@nhs.net


Abstract

Purpose:

The aim of this study was to assess the incidence of dural tears and compare the outcomes depending on management.

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).

Conclusion:

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.

Keywords: Incidental spinal durotomy, Spinal surgery, Complication rates, Lumbar, Suture repair.