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Corresponding Author

Mostafa Elaskary

Authors ORCID

Mostafa Elaskary: https://orcid.org/0009-0000-8867-4349

Article Type

Original Study

Abstract

Background: Incidental durotomies (IDs) that can occur during spine surgery are a complex issue with limited information about their true incidence and proper management. This study aims to document and present our experience in managing ID in a single medical setting, as well as the subsequent treatment protocols used in patients who have undergone various surgical procedures for degenerative lumbar spine disease, including both fresh and revision surgeries.

Methods: This retrospective review of 2,100 surgical cases over a seven-year period identified 110 patients with intraoperative ID. Management followed two protocols: Protocol A (direct repair with 5/0 silk running sutures, fat graft, and fibrin glue) and Protocol B (Protocol A measures plus a 12 French epidural suction drain and 2 days of bed rest). Outcome parameters included hospital stay, wound bogginess, low tension headache, neck meningism, wound infection, wound exploration, pseudomeningocele, intracranial hematoma, and CSF fistula.

Results: There was no significant variation between Protocol A and Protocol B regarding wound infection, the need for reexploration and debridement, pseudomeningocele, post-fossa ICH and SDH, and CSF fistula. However, there was a significant distinction between Protocol A and Protocol B regarding hospital stay, bogginess, low tension headache, and neck meningism.

Conclusion: Protocol A showed superior outcomes in reducing postoperative low-tension headaches and neck meningism, along with shorter hospital stays. These findings suggest Protocol A as the preferable management approach for IDs, enhancing recovery without increasing risk. Further prospective studies are recommended to validate and standardize treatment protocols.

Keywords

Incidental durotomy, CSF leak, Degenerative lumbar spine, Lumbar disc disease, Lumbar spine stenosis

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