Incidence of Dural Tears in Open versus Minimally Invasive Spine Surgery: A Single-Center Prospective Study

Abstract

Study Design: A prospective comparative study.Purpose: To compare the incidence of unintended durotomy and return to work after open surgery versus minimally invasive spine surgery (MIS) for degenerative lumbar pathologies.Overview of Literature: The incidence of accidental durotomy varies between 0.3% and 35%. Most of these are from open surgeries, and only a handful of studies have involved the MIS approach. No single-center studies have compared open surgery with MIS, especially in the context of early return to work and dural tear (DT).Methods: This study included 420 operated cases of degenerative lumbar pathology with a prospective follow-up of at least 6 months. Patients were divided into the open surgery and MIS groups, and the incidences of DT, early return to work, and various demographic and operative factors were compared.Results: A total of 156 and 264 patients underwent MIS and open surgery, respectively. Incidental durotomy was documented in 52 cases (12.4%); this was significantly less in the MIS group versus the open surgery group (6.4% vs. 15.9%, <i>p</i> <0.05). In the open surgery group, four patients underwent revision for persistent dural leak or pseudomeningocele, but none of the cases in the MIS group had revision surgery due to DT-related complications. The incidence of DT was higher among patients with high body mass index, patients with diabetes mellitus, and patients who underwent revision surgery (<i>p</i> <0.05) regardless of the approach. The MIS group returned to work significantly earlier.Conclusions: MIS was associated with a significantly lower incidence of DT and earlier return to work compared with open surgery among patients with degenerative lumbar pathology.

Incidental Dural Tears During Lumbar Spine Surgery: Prevalence and Evaluation of Management Outcomes

“…Concerning surgical approaches, the literature comparing the various approaches to surgery with regard to IDT incidence is scarce [ 18 ]. The risk of IDT is often only mentioned in relation to open or minimally invasive surgery in the majority of studies.…”

“…Notably, we only detected IDT in patients who had open surgery. In a prospective comparative study with 420 patients, Sharma et al found a higher rate of IDT in patients who underwent an open approach compared to a minimally invasive approach (15.9% vs. 6.4%, respectively) [ 18 ]. In a minimally invasive approach, minimal tissue retraction is required; the surgeon can avoid midline scar tissue and fibrosis in previously operated patients; and a small amount of ligamentum flavum or lamina is removed to access the disc during discectomy, resulting in a lower chance of IDT.…”

Recent Updates on Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

“…It has clinical and radiological outcomes comparable to open spine surgery, can reduce approach-related harm (a drawback of open surgery), and preserves normal anatomy. Thus, postoperative recovery and return to regular life is quick [ 5 , 6 ]. The benefits of MISS include less bleeding during the procedure, quicker recovery period, and fewer postoperative complications [ 7 ].…”

Does Conventional Open TLIF cause more Muscle Injury when Compared to Minimally Invasive TLIF?—A Prospective Single Center Analysis

“…Also, it reduces soft-tissue dissection and maintains structural integrity of paraspinal musculature. 6…”

“…Also, it reduces soft-tissue dissection and maintains structural integrity of paraspinal musculature. 6 Intramuscular pressure has been seen to increase substantially in conventional open posterior spine surgery with use of self retaining retractors. Up to 36.80% of multifidus muscle (MFM) atrophy was seen in patients undergoing conventional open TLIF (CO-TLIF).…”