Managing Unintentional Dural Tear in Spine Surgery: An Algorithmic Approach and Review of the Literature

Background: Incidental dural tears are among the most critical complications in spine surgery. It may be identified either intraoperatively or postoperatively. Dural tears management is multifaceted, influenced by factors such as the location of the tear and actual conditions. Despite numerous techniques reported in the literature for dural tear repair, spine surgeons have no consensus on this matter.  Methods: This narrative review explores existing articles and uses practical experience to propose an algorithmic approach for dural tears management. Additionally, this review evaluates other aspects of dural tears, including classification, risk factors, repair methods, the utility of drains, antibiotic prophylaxis, and dural tears in the context of vertebral fractures.  Results: By combining evidence-based recommendations with clinical expertise, this study seeks to provide a comprehensive understanding of dural tears in spine surgery and offer guidance for optimizing patient outcomes. Conclusion: An algorithmic approach integrating evidence and clinical expertise can guide effective management of dural tears in spine surgery, improving patient outcomes.