Abstract
Incidental durotomy is a relatively common occurrence during spinal surgery. There remains significant concern about this complication despite reports of good associated clinical outcomes. There have been few large clinical series on the subject.
Durotomy can cause postural headaches, nausea, vomiting, dizziness, photophobia, tinnitus, and vertigo and even severe meningitis and death.
Traditional management includes bed rest for up to 7 days to eliminate traction and reduce hydrostatic pressure during the healing process.
Methods: All patients who had spine surgery in our institute by the same surgeon during the last three years, enrolled into the study. Patients who did not have canal exploration as part of their procedure, were excluded.
Once durotomy had been recognized, immediate repair of the dura was done. An intra-operative Val-Salva maneuver was preformed and once no CSF leak was observed, the wound was tightly closed and no drains were left. In cases where no access to the leaking durotomy was possible, or the Val-Salva maneuver ended with CSF leak, a combination of fibrin glue and hemostatic materials were used to cover the dura.
On the first postoperative day the dressing was carefully inspected for any secretions. Patients who had their dressing dry and clean were allowed to get out of the bed with regular, unlimited, postoperative course. Patients who had a wet dressing due to CSF leak were instructed to stay in bed and a CD catheter was considered.
Results: There were 381 patients in the study group, 281 had instrumented procedures combined with canal decompression and 110 had decompression only. Incidental durotomy occured in 13 patients (3.4%); complete closure of the dura was possible in 10 while the rest had the fibrin glue sealing procedure. From the 3 patients, only one had a CD insertion due to continuous CSF leak, developed gram-negative meningitis and died. All accept the one patient had regular postoperative mobilization without any late CSF discharge or other related complications.
Conclusions: Although rare, incidental durotomy is one of the upsetting complications in spine surgery. No fixed, well-established protocol exists and the post-operative recommendation varies among surgeons.
Our experience shows that, based upon the described algorithm, one can safely mange patients who had incidental durotomy with a regular post-operative course.
The abstracts were prepared by Ms Orah Naor. Correspondence should be addressed to Israel Orthopaedic Association at PO Box 7845, Haifa 31074, Israel.
