Incidental durotomy in spine surgery: first aid in ten steps.
BACKGROUND
Incidental durotomy (ID) is the most common complication of spine surgery. Revision procedures, ossification of the yellow ligament, or synovial cysts are well-known risk factors. The size, shape, and severity of ID are unpredictable, ranging from a pinpoint hole to a several centimeters large dural laceration with transected fibers following the slippage of a cutting burr. Furthermore, the occurrence of ID is always unexpected. Intra-operative management is often based on a steep learning curve rather than a structured scheme.


OBJECTIVE
To provide an intra-operative ten-step closure technique (10ST) for IDs of varying severity.


METHODS
A database of 4020 consecutive surgeries for lumbar degenerative disease over the past 4 years was searched for ID. The records of 176 patients were analyzed. Two dural repair techniques were compared: the "individual" technique (InT) and the 10ST.


RESULTS
The overall prevalence of ID was 4.4%. The prevalence was lowest in virgin micro-discectomies (1.7%) and ranged from 3.6% in decompression for spinal canal stenosis up to 14.5% in revision procedures. All surgeries were performed with the aid of a microscope. Among 107 primary surgeries, the InT achieved a single-stage closure of the ID in 96 procedures (89.7%). Among 20 virgin surgeries, the 10ST was successful in all cases (P = 0.21). Among 42 re-do procedures following failed attempts to stop cerebrospinal fluid (CSF) leakage, the InT achieved single-stage closure in 36 procedures (85.7%). The 10ST was successful in all 26 cases (P = 0.03). The follow-up was 1 year.


CONCLUSIONS
The 10ST should be considered for successful single-stage closure in primary repair of ID.
Clinic for Spine Surgery, Schoen Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany, lpapavero@schoen-kliniken.de.
Luca
L
Papavero
Nils
N
Engler
Ralph
R
Kothe
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology / Q000601:surgery*; D019299:Decompression, Surgical; D017586:Diskectomy; D004388:Dura Mater / Q000293:injuries / Q000601:surgery*; D005260:Female; D005392:First Aid; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000601:surgery*; D059032:Learning Curve; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors