Incidental Dural Tears during Lumbar Surgery: Incidence and Management

Background In spite of the fact that incidental dural tears (IDTs) are well-known intraoperative complication during lumbar surgery, true incidence is not accurately known, and different techniques have been suggested for management

Aim of the Work Detect IDTs in lumbar surgery with evaluation of our intraoperative technique used for management.

Materials and Methods A total of 834 degenerative lumbar spine cases were reviewed, during the period from 2008 till 2013, in our institutions. Among those cases, 191 were recurrent cases. Cases complicated with IDTs were identified and managed intraoperatively using our technique that was based on many layers' tight closure; cases with persistent leak that needs reoperation are identified and reviewed

Results The incidence of ITDs during lumbar surgery in our series was 7.3% (61 of 834 cases). During primary surgery, it was 5.9% (38 of 643 cases) and among recurrent cases it was 12% (23 of 191 cases); all cases were repaired intraoperatively using 3–0 vicryl suture and a muscle graft was sutured as an enforcing layer; tight closure of fascia, subcutaneous, subcuticular layers, and skin, and no subfascial drains were used used. One case showed persistent leakage and two cases complicated with pseudomeningocele; cases of pseudomeningocele were managed conservatively and the case of leakage reoperated, with no further complications.

Conclusion IDTs is a common complication in lumbar surgery with a higher incidence in recurrent cases. The cornerstone in the management of IDTs is intraoperative identification and tight closure in many layers that was proved by our surgical technique. Success rate was 98.4%, and 1 case of 61 cases (1.6%) needed a second operation.

Keywords degenerative lumbar spine; dural tears; complication of lumbar surgery; CSF leakage