Incidence and Management of Incidental Spinal Durotomies Noticed During Spinal Surgery
Ishvinder Singh Grewal1, Urpinder Singh Grewal2, *, Tom Eadsforth3, Christopher Barrett3, Robin Pillay3
Identifiers and Pagination:Year: 2019
First Page: 47
Last Page: 52
Publisher Id: TOORTHJ-13-47
Article History:Received Date: 23/10/2018
Revision Received Date: 2/1/2019
Acceptance Date: 21/1/2019
Electronic publication date: 20/02/2019
Collection year: 2019
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.
The aim of this study was to assess the incidence of dural tears and compare the outcomes depending on management.
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.
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).
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.