title: The intra- and postoperative management of accidental durotomy in lumbar spine surgery: results of a German survey.
abstract: BACKGROUND
  The intra- and postoperative management of accidental durotomy in operations of the lumbar spine is not standardized. It is the aim of our survey to obtain an overview on the current practice in neurosurgical departments in Germany.
  
  
  METHODS
  The used questionnaire consisted of three questions and could be answered within a few minutes by checking boxes. In September 2012, the questionnaire was sent to 149 German neurosurgical departments. In the following 4 weeks 109 replies (73.2 %) were received.
  
  
  RESULTS
  Seventy-one neurosurgical departments (65.1 %) treat dural tears by a combination of methods, 28 (25.7 %) with suture alone, 7 (6.4 %) with fibrin-coated fleeces alone, 2 (1.8 %) with muscle patch alone and 1 (0.9 %) with fibrin glue alone. Sixty-six neurosurgical departments (60.5 %) decide on postoperative bed rest depending on the quality of the dural closure. Forty-three (39.5 %) neurosurgical departments do not rely on the quality of the dural closure for their postoperative management. In total, 72.5 % of the neurosurgical departments prescribe bed rest for 1-3 days, 1.8 % for more than 3 days, whereas 25.7 % allow immediate mobilization.
  
  
  CONCLUSIONS
  Among German neurosurgeons, no consensus exists concerning the intra- and postoperative management of accidental durotomies in lumbar spine surgery. Despite not being proved to reduce the rate of cerebrospinal fluid fistulas, bed rest is frequently used. As bed rest prolongs the hospital stay with additional costs and has the potential of a higher rate of medical complications, a prospective multicenter trial is warranted.
authors.affiliation: Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany, christin.clajus@googlemail.com.
authors.forename: Christin
authors.initials: C
authors.lastname: Clajus
authors.forename: Florian
authors.initials: F
authors.lastname: Stockhammer
authors.forename: Veit
authors.initials: V
authors.lastname: Rohde
mesh_terms: D001510:Bed Rest; D003625:Data Collection; D004388:Dura Mater / Q000293:injuries*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005858:Germany; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000517:prevention & control / Q000628:therapy*; D011446:Prospective Studies; D013503:Surgery Department, Hospital / Q000592:standards; D013537:Sutures
chemical_list: D015718:Fibrin Tissue Adhesive