Incidental Durotomy in Lumbar Spine Surgery; Risk Factors, Complications, and Perioperative Management

Abstract

Incidental durotomy (ID) can occur in up to 14% of all lumbar spine surgeries. The risk of this complication is markedly higher among elderly patients with advanced spinal pathology. In addition, revision cases and other more invasive procedures increase the risk of ID. When unrepaired, IDs can increase the risk of developing meningitis and can lead to the formation of cerebrospinal fluid fistulas and pseudomeningoceles. Intraoperative recognition and repair are essential to ID management, although repair techniques vary considerably. Although primary suture repair is considered the “benchmark,” indirect repair alone has shown comparable outcomes. Given the concern for infection after ID, many have indicated for prolonged prophylactic antibiotic regimens. However, there is little clinical evidence that this is necessary after adequate repair. The addition of subfascial drains have been shown to promote wound healing and early ambulation, whereas no consensus on duration of indwelling drains exists and such management is largely case dependent. Early ambulation after surgery has not shown to be associated with increased risk of further ID complications and decreases rehabilitation time, length of stay, and risk of venous thromboembolism. However, there remains a role for conservation mobilization protocols in more severe cases where notable symptoms are observed.

Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management

“…Our data showed no effect on CSFL development, suggesting a generally safe applicability with reduced or no force of suction. It does not allow further conclusions such as previous reports advocating for epidural drainage placement in order to reduce the risk of CSFL by influencing epidural pressure gradients and thus supporting wound healing (16,20). Furthermore, our results are inconsistent with reports of increased complication rates, including CSFL, following epidural drainage in both planned and accidental durotomy (3,(21)(22)(23)(24).…”

“…Use of fibrin sealants has been discouraged by several authors following both planned and unplanned durotomies due to a lack of effectiveness in preventing CSFL ( 10 , 14 – 16 ), even though two studies reported favorable results ( 4 , 17 ). The effectiveness and the necessity of patch sealants to prevent CSFL are not sufficiently studied in planned durotomies.…”

“…The placement of an epidural drainage following durotomy is controversially discussed ( 16 , 19 ). Our data showed no effect on CSFL development, suggesting a generally safe applicability with reduced or no force of suction.…”

Natural language processing in low back pain and spine diseases: A systematic review

“…Incidental durotomy (ID) identification. Incidental durotomy (ID) is a common intra-operative complication during spine surgery, occurring up to 14% of lumbar spine surgeries [ 29 ]. It is defined as an inadvertent tearing of the dura during surgery with cerebrospinal fluid (CSF) extravasation or bulging of the arachnoid [ 30 ].…”

Risk Factors for Venous Thrombosis after Spinal Surgery: A Systematic Review and Meta-analysis

“…Acute thromboembolic illness (VTE) may result in substantial morbidity, poor quality of life, and even death [ 3 ]. It may also lead to increased medical costs and a considerable financial burden on individuals and their families [ 4 ]. The use of pharmacological prophylaxis is well established in a variety of surgical procedures, most notably hip and knee replacements, for which there are well-established criteria and dosing guidelines [ 5 ].…”