title: Management of Incidental Dural Tear During Lumbar Spine Surgery. To Suture or Not to Suture?
abstract: OBJECTIVE
  Incidental durotomy (ID) during lumbar spine surgery is a frequent complication of growing clinical relevance as the number and complexity of spinal procedures increases. Yet, there is still a lack of guidelines for the treatment of ID with a large heterogeneity of established surgical techniques. The aim of this study was to investigate the efficacy of dural suturing in patients having ID during degenerative lumbar spine surgery, compared with other dural closure techniques.
  
  
  METHODS
  Of 1173 consecutive patients undergoing degenerative lumbar spine surgery from July 2013 to March 2015, in 64 (5.4%) patients 69 (5.8%) IDs occurred. The patients were divided into 3 groups depending on the dural closure technique used: group A, sole dural suture (n = 12, 19%); group B, patch only (TachoSil and/or muscle and/or fat) (n = 22, 32%); group C, dural suture in combination with a patch (n = 34, 49%). The primary end point was revision surgery caused by complications of cerebrospinal fluid leakage after 6 weeks. The secondary end points were operation time and hospitalization time, as well as surgical morbidity.
  
  
  RESULTS
  The 3 groups showed no significant difference in rates of revision surgery (group A: n = 1, 1.4%; group B: n = 4, 5.8%; group C: n = 3; 4.3%; P = 0.5). Furthermore, no significant difference for hospitalization time, operation time, and clinical outcome was found. Extent of ID, American Society of Anesthesiology score, postoperative immobilization, and insertion of a drainage tube were not associated with higher rates of revision surgery. Applying suction once a drainage tube was placed was found to be a significant risk factor for revision surgery (P = 0.003). Furthermore, patients undergoing revision surgery had a significantly higher body mass index (33 kg/m(2) vs. 26.37 kg/m(2); P = 0.006; odds ratio 1.252; P = 0.004).
  
  
  CONCLUSIONS
  Based on our results, the dural closure technique after ID does not seem to influence revision surgery rates due to cerebrospinal fluid leakage and its complications. Further prospective randomized studies are needed to confirm our results.
authors.affiliation: Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital of Basel, Basel, Switzerland. Electronic address: maria_kamenova@web.de.
authors.forename: Maria
authors.initials: M
authors.lastname: Kamenova
authors.affiliation: Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital of Basel, Basel, Switzerland.
authors.forename: Severina
authors.initials: S
authors.lastname: Leu
authors.affiliation: Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.affiliation: Department of Spine Surgery, University Hospital of Basel, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schaeren
authors.affiliation: Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital of Basel, Basel, Switzerland.
authors.forename: Jehuda
authors.initials: J
authors.lastname: Soleman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004388:Dura Mater / Q000293:injuries*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery; D007902:Length of Stay; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012086:Reoperation / Q000706:statistics & numerical data; D013537:Sutures; D016896:Treatment Outcome
keywords: Closure techniques; Dural suturing; Incidental dural tear; Lumbar spine surgery