Our Experience in the Management of Dural Tears in Lumbar Spine Surgery
Abstract
Introduction: Incidental durotomy is a recognized complication in spine surgery. Its management usually includes suturing and, occasionally, augmentation techniques; however, there is no consensus regarding the optimal treatment strategy. The aim of this study was to present our institutional experience in the management of incidental durotomy using a standardized dural repair protocol. Materials and Methods: A retrospective study was conducted including 1,040 patients who underwent posterior lumbosacral spine surgery for herniated or degenerative disc disease between 2000 and 2023. Procedures included discectomy, decompression with or without arthrodesis and instrumentation, in both primary and revision surgeries. Thirty-seven patients with incidental durotomy were identified and treated according to an institutional protocol, with a minimum follow-up of two years. Results: Thirty-seven of the 1,040 patients (mean age: 48 years) sustained a dural tear. All cases were diagnosed intraoperatively and treated with 4-0 nylon sutures, with local fascia augmentation according to defect size; 11 required augmentation. Three patients developed persistent cerebrospinal fluid leakage without associated symptoms, which was successfully managed with bed rest, Trendelenburg positioning, and acetazolamide. Two patients developed surgical site infection and required debridement and targeted antibiotic therapy. No recurrences were observed during follow-up. Conclusions: The institutional protocol for the management of incidental durotomy proved effective in preventing complications, reducing morbidity, and lowering associated healthcare costs. Its systematic application may contribute to standardizing the management of this complication in spine surgery.Downloads
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