title: Accidental Durotomy in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Frequency, Risk Factors, and Management.
abstract: OBJECTIVE
  To assess the frequency, risk factors, and management of accidental durotomy in minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
  
  
  METHODS
  This single-center study retrospectively investigates 372 patients who underwent MIS TLIF and were mobilized within 24 hours after surgery. The frequency of accidental durotomies, intraoperative closure technique, body mass index, and history of previous surgery was recorded.
  
  
  RESULTS
  We identified 32 accidental durotomies in 514 MIS TLIF levels (6.2%). Analysis showed a statistically significant relation of accidental durotomies to overweight patients (body mass index ≥ 25 kg/m(2); P = 0.0493). Patient age older than 65 years tended to be a positive predictor for accidental durotomies (P = 0.0657). Mobilizing patients on the first postoperative day, we observed no durotomy-associated complications.
  
  
  CONCLUSIONS
  The frequency of accidental durotomies in MIS TLIF is low, with overweight being a risk factor for accidental durotomies. The minimally invasive approach seems to minimize durotomy-associated complications (CSF leakage, pseudomeningocele) because of the limited dead space in the soft tissue. Patients with accidental durotomy can usually be mobilized within 24 hours after MIS TLIF without increased risk. The minimally invasive TLIF technique might thus be beneficial in the prevention of postoperative immobilization-associated complications such as venous thromboembolism. This trial is registered with DRKS00006135.
authors.affiliation: Department of Neurosurgery, Freiburg University Medical Center, 79106 Freiburg, Germany.
authors.forename: Jan-Helge
authors.identifier: 0000-0003-3469-9027
authors.initials: JH
authors.lastname: Klingler
authors.affiliation: Department of Neurosurgery, Freiburg University Medical Center, 79106 Freiburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Volz
authors.affiliation: Department of Neurosurgery, Freiburg University Medical Center, 79106 Freiburg, Germany.
authors.forename: Marie T
authors.initials: MT
authors.lastname: Krüger
authors.affiliation: Department of Neurosurgery, Freiburg University Medical Center, 79106 Freiburg, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kogias
authors.affiliation: Department of Neurosurgery, Freiburg University Medical Center, 79106 Freiburg, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Rölz
authors.affiliation: Department of Neurosurgery, Freiburg University Medical Center, 79106 Freiburg, Germany.
authors.forename: Christoph
authors.identifier: 0000-0003-1469-2901
authors.initials: C
authors.lastname: Scholz
authors.affiliation: Department of Neurosurgery, Freiburg University Medical Center, 79106 Freiburg, Germany.
authors.forename: Ronen
authors.initials: R
authors.lastname: Sircar
authors.affiliation: Department of Neurosurgery, Freiburg University Medical Center, 79106 Freiburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hubbe
mesh_terms: D000368:Aged; D002921:Cicatrix; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D000267:Tissue Adhesions