Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Unintended durotomy is a common occurrence during lumbar spinal surgery, particularly in surgery for degenerative spinal conditions, with the reported incidence rate ranging from 0.3% to 35%. The authors performed a systematic literature review on unintended lumbar spine durotomy, specifically aiming to identify the incidence of durotomy during spinal surgery for lumbar degenerative conditions. In addition, the authors analyzed the incidence of durotomy when minimally invasive surgical approaches were used as compared with that following a traditional midline open approach.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A MEDLINE search using the term “lumbar durotomy” (under the 2015 medical subject heading [MeSH] “cerebrospinal fluid leak”) was conducted on May 13, 2015, for English-language medical literature published in the period from January 1, 2005, to May 13, 2015. The resulting papers were categorized into 3 groups: 1) those that evaluated unintended durotomy rates during open-approach lumbar spinal surgery, 2) those that evaluated unintended durotomy rates during minimally invasive spine surgery (MISS), and 3) those that evaluated durotomy rates in comparable cohorts undergoing MISS versus open-approach lumbar procedures for similar lumbar pathology.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The MEDLINE search yielded 116 results. A review of titles produced 22 potentially relevant studies that described open surgical procedures. After a thorough review of individual papers, 19 studies (comprising 15,965 patients) pertaining to durotomy rates during open-approach lumbar surgery were included for analysis. Using the Oxford Centre for Evidence-Based Medicine (CEBM) ranking criteria, there were 7 Level 3 prospective studies and 12 Level 4 retrospective studies. In addition, the authors also included 6 studies (with a total of 1334 patients) that detailed rates of durotomy during minimally invasive surgery for lumbar degenerative disease. In the MISS analysis, there were 2 prospective and 4 retrospective studies. Finally, the authors included 5 studies (with a total of 1364 patients) that directly compared durotomy rates during open-approach versus minimally invasive procedures. Studies of open-approach surgery for lumbar degenerative disease reported a total of 1031 durotomies across all procedures, for an overall durotomy rate of 8.11% (range 2%–20%). Prospectively designed studies reported a higher rate of durotomy than retrospective studies (9.57% vs 4.32%, p = 0.05). Selected MISS studies reported a total of 93 durotomies for a combined durotomy rate of 6.78%. In studies of matched cohorts comparing open-approach surgery with MISS, the durotomy rates were 7.20% (34 durotomies) and 7.02% (68), respectively, which were not significantly different.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Spinal surgery for lumbar degenerative disease carries a significant rate of unintended durotomy, regardless of the surgical approach selected by the surgeon. Interpretation of unintended durotomy rates for lumbar surgery is limited by a lack of prospective and cohort-matched controlled studies.</jats:p></jats:sec>

Unintended Dural Injury in Degenerative Lumbar Spinal Surgery: A Retrospective Study

“…Unintended dural injury is a common complication during degenerative lumbar spine surgery (Figure 1-2). Dural injury rate is between 0.2% and 20% in all spinal surgeries (1)(2)(3)(4)10) . In open surgery series for lumbar degenerative process, unintended dural injury rate was 8.11% (range: 2-20%).…”

Spinal subdural hygroma as a post-operative complication in revision spine fusion: a case report

“…Although relatively rare, an incidental durotomy can happen during spinal procedures such as lumber spine fusion [2, 6]. A subdural hygroma is a collection of CSF that develops between the dura and the arachnoid layers.…”

“…Lumber spinal surgery for degenerative disorders is a common procedure, with the number of fusions increasing over 70% from 2001 to 2011 [1]. There is a 2–20% incidence of dural tears during lumbar spinal surgery for degenerative conditions [2] . The rate increases when undergoing revision surgery [3].…”

Complications following central corpectomy in 468 consecutive patients with degenerative cervical spine disease

“…O'Neill et al 46 note a similar association and attributed it to age-related loss of tensile strength of the dura, which has also been observed in lumbar spine surgery. 20,61,66 …”