title: Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  To review the experience of a single institution with degenerative lumbar surgery and to identify cases of incidental dural tears (DTs); and to report on the efficacy of our postoperative management protocol for DT, which relies on early mobilization.
  
  
  BACKGROUND
  DTs are a common complication of degenerative lumbar spine surgery. However, the management strategies for this complication vary from one surgeon to another.
  
  
  METHODS
  A total of 3,183 degenerative lumbar spine cases (decompression and/or fusion) were reviewed. Cases complicated by an incidental DT were identified. Patients who required a return to the operating room for a second procedure were identified and the operative findings were reviewed.
  
  
  RESULTS
  The incidence of DT during primary lumbar surgeries was 7.6% (153 of 2,024 cases), which compares to an incidence of 15.9% for revision cases (185 of 1,159 cases). If recognized during the index procedure, all DTs were repaired using a 4-0 silk suture. Six patients (4 primary, 2 revisions) who did not improve despite our postoperative management protocol were taken to the operating room for irrigation and debridement, repair of the defect, and placement of a subfascial drain to closed suction. All 6 patients went on to do well and did not have any further complications.
  
  
  CONCLUSIONS
  DTs are common during degenerative lumbar spine surgery. Revision surgery is twice as likely as primary surgery to result in this complication. Our postoperative early mobilization protocol appears to be an effective and safe management strategy for treating this complication (98.2% success rate). Very few patients (6 of 338, or 1.8%) needed a reoperation.
authors.affiliation: Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Mustafa H
authors.initials: MH
authors.lastname: Khan
authors.forename: Jeffery
authors.initials: J
authors.lastname: Rihn
authors.forename: Garen
authors.initials: G
authors.lastname: Steele
authors.forename: Rick
authors.initials: R
authors.lastname: Davis
authors.forename: William F
authors.initials: WF
authors.lastname: Donaldson
authors.forename: James D
authors.initials: JD
authors.lastname: Kang
authors.forename: Joon Y
authors.initials: JY
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000009:adverse effects; D019468:Disease Management; D004388:Dura Mater / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects