title: Surgical dural tears: prevalence and updated management protocol based on 1359 lumbar vertebra interventions.
abstract: BACKGROUND
  The dural tear is a dreaded complication of lumbar surgery.
  
  
  OBJECTIVE
  Our management protocol has made it possible to deal with this problem effectively.
  
  
  METHODS
  Retrospective review of 1359 patients operated between 2000 and 2010. In the event of dural tear, a therapeutic protocol was applied: suturing the dural wound if possible. A collagen patch lined with a layer of fibrin glue protected the suture. If the suture was considered tight, a non-aspirating drain was set up for 48h. In the other cases, no drain was set up. All the patients were left supine for 48h and they received intravenous antibiotics for the same duration. We analyzed the number and the type of breaches, the possibility of suturing, clinical symptoms (headache), and delayed complications (dural fistula or meningoceles).
  
  
  RESULTS
  The 1359 procedures included 23 dural tear complications (1.7%). The tears were often small in size and reparable. There were no late complications detected: no symptomatic fistula or meningocele. None of the patients had a second surgery.
  
  
  CONCLUSIONS
  This protocol provided effective management of dural tears in lumbar surgery, with no application problems. We suggest a number of improvements: the use of the Valsalva maneuver to test the suturing, a stand-up test for the patient, and a systematic late MRI to detect meningoceles. There is no reason to change the other points in the protocol: suturing, controlled drainage for watertight wounds, no drainage for the non-watertight wounds, antibiotics, and supine bed rest position 48h.
  
  
  METHODS
  Level IV. Retrospective study.
authors.affiliation: Department of Orthopaedics, Paris-Saint-Joseph Hospital Group, 185 rue Raymond-Losserand, Paris, France. swolff@hpsj.fr
authors.forename: S
authors.initials: S
authors.lastname: Wolff
authors.forename: W
authors.initials: W
authors.lastname: Kheirredine
authors.forename: G
authors.initials: G
authors.lastname: Riouallon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult