Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review.
METHODS
Retrospective review of a series of patients who underwent spinal surgery at a single spine unit during a 1 year period.


OBJECTIVE
To assess the incidence, treatment, clinical consequence, complications of incidental durotomy during spine surgery and results of 37 months clinical follow-up.


BACKGROUND
Incidental durotomy is an underestimated and relatively adverse event during spinal surgery. Several consequences of inadequately treated dural tears have been reported.


METHODS
A retrospective review was conducted on 1326 consecutive patients who underwent spinal surgery performed in one French spine unit from January 2005 to December 2005. We excluded from this study patients treated for emergency spine cases.


RESULTS
Fifty-one dural tears were identified (3.84%). Incidental durotomies were associated with anterior cervical approach in 1 case, with posterior cervical approach in 1 case, with anterior retroperitoneal approach in 1 case and with posterior thoracolumbar approach in 48 cases. In addition, any clinically significant durotomy unrecognised during surgical procedure were included. Thirteen patients presented postoperative complications including 7 cerebrospinal fluid leaks, 2 wound infections, 2 postoperative haematomas, and 2 pseudomeningoceles. Nine of these 13 patients required a revision procedure. A mean follow-up of 37 months showed good long-term clinical results.


CONCLUSIONS
Incidental durotomy is a common complication of spine surgery. All incidental durotomies must be repaired primarily. Dural tears that were immediately recognised and treated accordingly did not lead to any significant sequelae at a mean follow-up of 37 months. However, long-term follow-up studies will be needed to confirm this finding. The risks associated with dural tears and cerebrospinal fluid leaks are serious and should be discussed with any patients undergoing spine surgery.
Department of Orthopaedic Surgery, University Hospital of Bordeaux, Spinal Unit, Place Amélie Raba Léon, Bordeaux, France. pguerin_patrick@yahoo.fr
Patrick
P
Guerin
Abdelkrim Benchikh
AB
El Fegoun
Ibrahim
I
Obeid
Olivier
O
Gille
Luc
L
Lelong
Stéphane
S
Luc
Anouar
A
Bourghli
Jean Christophe
JC
Cursolle
Vincent
V
Pointillart
Jean-Marc
JM
Vital
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea; D004388:Dura Mater / Q000293:injuries* / Q000601:surgery; D005260:Female; D013502:General Surgery / Q000193:education / Q000592:standards; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome