Management and Outcomes of Intentional Durotomies

Introduction: Intradural surgery is being performed increasingly for the management of benign and malignant tumors occurring in the spine. This type of surgery requires an intentional durotomy-the deliberate opening of the dura mater. Currently, no standards or guidelines have been set in the management of these patients undergoing intradural surgery. At this time, intentional durotomies are generally managed in the same manner as a dural tear with a primary closure, watertight layered closure, and flat bed rest as initially proposed by EIsmont et al.

Aims: The aims of the present study are (1) to compare and contrast different methods of primary repair of intentional durotomies and their outcomes and (2) to assess the benefit of bed rest in patients following intradural surgery.

Methods: This is a retrospective observational study which analyzes all intradural surgery cases over a 5-year period at The Walton Centre, Liverpool, United Kingdom.

Results: Total of 120 patients were identified for this study. Full data were available for 84 of these patients. The mean age of the patients was 52 years (17 to 81) and the male:female ratio was 38:46. Follow-up period was 0 to 6 years. Methods of primary repair ranged from no repair to various combinations of suture, glue, and grafts. The best method of primary repair was with “sutures and glue” revealing only a 4.26% complication rate. “Sutures only,” “sutures, glue, and graft,” and “glue and graft” techniques had higher complication rates; 12.5, 8.3, and 40%, respectively. Postoperatively 74% of patients were mobilized immediately with a complication rate of 8%. Those who had delayed mobilization (26%) had a complication rate of 9%.

Conclusions: Repairing an intentional durotomy with a “suture and glue” technique leads to a lower rate of postoperative complications. Furthermore, there appears to be no statistical benefit of prolonged bed rest following intradural surgery on patient outcome.