Incidental Durotomy Repair in Lumbar Spine Surgery: Institutional Experience and Review of Literature

Incidental durotomies (IDs), or tears in the membrane surrounding the spinal cord, are a common complication during spine surgery. This study reviews current management strategies for IDs, presents the authors' institution's experience with case examples, and proposes a step-wise management approach. The proposed algorithm begins with a primary repair of the dural tear, potentially reinforced with sealants or a muscle patch. If this initial repair fails, the next step involves a paraspinal muscle flap and a lumbar drain to divert cerebrospinal fluid (CSF). In cases where the patient cannot be weaned off CSF diversion, a long-term CSF diversion via a lumboperitoneal shunt may be necessary. These shunts can be removed once clinical and radiographic signs of CSF leak are resolved.

• 1
  There is no standardized approach to managing incidental durotomies (IDs) and cerebrospinal fluid (CSF) leaks in lumbar spine surgery, highlighting a need for a consensus.
• 2
  In this study of 1133 patients, 116 cases (10.2%) had intraoperative evidence of incidental durotomy (ID).
• 3
  Postoperative postural headache was the most frequently reported symptom among the 30 patients presenting with postoperative CSF leak-related symptoms (90%).