Incidental Durotomy during Lumbar Spine Surgery: Management and Complications. A Retrospective Review

Background: An incidental dural tear is a frequent intraoperative complication of spine surgery. Various studies have reported incidences ranging from 1% to 17%. Cerebrospinal fluid (CSF) leakage is a potential complication resulting from a dural violation during spinal surgery. Objectives: The aim of this study is to evaluate different modalities of management of uintended durotomy during lumbar spine surgery. Patients and Methods: Thirty patients (twenty two males and eight females) who were subjected to uintended durotomy in lumbar spine surgery in Ain Shams University hospitals were included in the study. They were evaluated for different modalities of management of unintented durotomy. Results: 46.66% (fourteen cases) of our patients had a de novo lumbar pathology and 53.33% were recurrent cases. As regard the operated spinal level L4-5 was the most involved level in twenty cases (67.67%) and L1-2 the least in one case (3.33%). Intra operative site of dural tear was dorsal in 19 cases (65.5%), ventral in two cases (6%) and lateral in 8 cases (27.5%). In twenty four patients a subfascial drain was kept, while six patients had no subfascial drain. Post operative insertion of subarachnoid lumbar drain was done in seven patients with failure in two patients. The infection rate with the use of lumbar subarachnoid drain was (14.2%). Conclusion: Although the reported results constitute a preliminary data of along term follow up of patients with incidental durotomy and post operative CSF leakage. These results point to: no difference in success rate between patients with sutured fat graft, sutured muscle graft and Duragen. Better results in patients managed without subfascial drain.