Management of Different Post-Operative Outcomes Due to Incidental Durotomy During Lumbar Spine Surgery, Single Institute Experience: Case Series

Abstract Background: Unintended incidental dural tear is an un-derrated and unpleasant event during spine procedures. Many outcomes of improperly managed dural tears have been noted. A retrospective study was carried on about 1217 consecutive patients who had lumbar spine surgery done in a single institute from February 2016 to February 2021. We excluded patients with emergency lumbar spine pathologies and lumbar spine surgeries performed in the pediatric age group. Aim of Study: The main aim of this study was to detect the incidence, management of post-operative complications due to incidental dural tear during lumbar surgery and results after 6 months follow-up clinically. Patients and Methods: A retrospective review was con-ducted on about 1217 consecutive patients who underwent lumbar spine surgery performed in one institute from February 2016 to February 2021. We excluded patients treated for emergency lumbar spine cases and lumbar spine surgeries performed in the pediatric age group. Results: 1217 patients underwent lumbar spine surgery in 5 years. Of those, we identified 180 patients with unintended dural injury. All incidental durotomies were recognized either intra-operatively or during the post-operative period and managed accordingly by either water-tight closure using primary sutures, muscle grafts, fat grafts or lumbar drain in some cases after failure of conservative measures. We never used tissue glue in our study. Conclusions: Incidental durotomy is a frequent and not uncommon drawback of lumbar spinal surgery. Primary dural closure with water-tight running sutures is the method of choice in cases with intra-operative incidental durotomy. The combination of this method with fat grafts or muscle grafts would secure the closure even better with great cautious when using subfacial drains, as the use of drains beneath fascia in such cases would facilitate cerebrospinal fluid (CSF) leak. Invasive measures such as lumbar drains and/or surgical revision should always be kept in mind and planned after failure of conservative measures.