Abstract
There is increasing awareness of the need to inform patients of common complications that occur during surgical procedures. During lumbar spine surgery, incidental tear of the dural sac and subsequent cerebrospinal fluid leak is possibly the most frequently occurring complication. There is no consensus in the literature about the rate of dural tears in spine surgery. We have undertaken this study to evaluate the incidence of dural tears among spine surgeons in the United Kingdom for commonly performed spinal procedures. Prospective data was gathered for 1,549 cases across 14 institutions in the United Kingdom. The results give us a baseline rate for the incidence of dural tears. The rate was 3.5% for primary discectomy, 8.5% for spinal stenosis surgery and 13.2% for revision discectomy. There was a wide variation in the actual and estimated rates of dural tears among the spine surgeons. The results confirm that prospective data collection by spine surgeons is the most efficient and accurate way to assess complication rates for spinal surgery.
Similar content being viewed by others
References
Alexander A, Jones M, Stambough JL et al (1989) Long-term results of lumbar spine surgery complicated by unintended incidental durotomy. Spine 14(4):443–446
Bosacco SJ, Gardner MJ, Guille JT (2001) Evaluation and treatment of dural tears in lumbar spine surgery—a review. Clin Orthop 389:238–247
Camissa FP, Girardi FP, Sangani PK et al (2000) Incidental durotomy in spine surgery. Spine 25(20):2663–2667
Goodkin R, Laska LL (1995) Unintended “incidental” durotomy during surgery of the lumbar spine: medicolegal implications. Surg Neurol 43:4–12
Hodges SD, Humphreys CS, Eck JC et al (1999) Management of incidental durotomy without mandatory bed rest: a retrospective review of 20 cases. Spine 24(19):2062–2065
Torrens MJ, Dickson RA (1991) Operative spinal surgery. Churchill Livingstone, Edinburgh
Oxford Centre for Evidence Based Medicine (2001) Levels of evidence. http://www.cebm.net. Cited May 2001
Hardy RW (1997) Lumbar discectomy: surgical tactics, chap 90. In: Frymoyer JW (ed) The adult spine, principles and practice, 2nd edn. Lippincott-Raven, Philadelphia
Stolke D, Sollmann W, Seifert V (1989) Intra- and postoperative complications in lumbar disc surgery. Spine 14:56–59
Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine: management and results after a two-year minimum follow-up of eighty-eight patients. JBJS 80:1728–1732
Author information
Authors and Affiliations
Corresponding author
Additional information
This research was carried out at the Leicester General Hospital, Leicester, UK.
Appendices
Appendix
BRITISH ASSOCIATION OF SPINE SURGEONS
AUDIT OF DURAL TEARS 2002
Discectomy - Revision Discectomy - Spinal Stenosis
Please complete this audit sheet to the best of your ability. The accuracy of data is important but we recognise that not everyone has a database for easy recall. A dural tear is where there is free CSF seen, or a dural leak is subsequently apparent. Comments would be helpful and the way you deal with them would also be of interest.
NAME ..................................... HOSPITAL ..........................................
Neurosurgeon/Orthopaedic surgeon (delete as applicable)
Primary discectomy
Number of index cases ....... No. of dural tears .......
Do you use a microscope for these? YES/NO
Revision discectomy
Number of index cases ....... No. of dural tears .......
Spinal stenosis
Number of index cases ....... No. of dural tears ......
These figures are accurate as I keep a prospective database YES/NO
These figures are estimates of numbers of cases carried out YES/NO
I have guessed as I have no way of recording what occurs YES/NO
My method of dealing with a dural tear is as follows: (please include type of suture material, drain or not, bed-rest or not, antibiotics and mobilisation plan)
............................................................................................................
............................................................................................................
............................................................................................................
............................................................................................................
............................................................................................................
............................................................................................................
Return to Philip Sell, BASS, Department of Orthopaedics, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW
Rights and permissions
About this article
Cite this article
Tafazal, S.I., Sell, P.J. Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J 14, 287–290 (2005). https://doi.org/10.1007/s00586-004-0821-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-004-0821-2