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Research ArticleMinimally Invasive Surgery

Safe Discharge of Patients From an Ambulatory Care Center After Incidental Durotomy During Minimally Invasive Spine Surgery

Thomas L. Francavilla, Michael C. Weiss and Reginald Davis
International Journal of Spine Surgery August 2019, 6053; DOI: https://doi.org/10.14444/6053
Thomas L. Francavilla
1Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana
MD
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Michael C. Weiss
2Department of Surgery, Laser Spine Institute, Tampa, Florida
DO
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Reginald Davis
2Department of Surgery, Laser Spine Institute, Tampa, Florida
MD
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ABSTRACT

Background Incidental durotomy is a well-known complication of spinal surgery that may occur occasionally. Increasingly, minimally invasive techniques are being used for spinal decompressions in an ambulatory surgical center (ASC) setting. The management of this complication in an ASC setting has not been reported.

Methods A total of 832 consecutive minimally invasive decompressive spinal surgeries were performed by a single surgeon in an ASC during the course of 1 year. Incidental durotomies with cerebrospinal fluid leakage were repaired and patients were discharged to home. Patients with a watertight suture dural repair did not receive any modifications to the usual discharge activities allowed. All other patients were treated with bed rest overnight and head of bed restrictions. A protocol for close patient follow-up after discharge was followed. The complications were collected prospectively and analyzed retrospectively.

Results There were 30 incidental durotomies (3.6%), with all occurring in the lumbar spine. Suture repair was accomplished in 28 patients (93%). Patch repair was performed in 2 patients (7%). All patients were discharged to home from the ASC. There were 2 short-term complications noted after discharge. The patient safety protocols in place identified the complications and allowed timely interventions.

Conclusions Incidental durotomy occurring during minimally invasive spinal decompressive surgery is an occasional event. Suture repair of the laceration is feasible in most instances. Lumbar spine patients may be safely discharged to home from the ASC. Patients can be stratified into those with, or without, a watertight suture dural closure. Those with such a closure, who are without symptoms of intracranial hypotension, do not require modification of their activities. A short period of bedrest with head of bed modification successfully treated the remainder. Hospitalization or routine prolonged bed rest is not necessary. Protocols must be put in place to identify and timely manage potentially serious sequelae.

  • incidental durotomy
  • CSF leakage
  • minimally invasive spine surgery
  • ambulatory surgery
  • complications
  • dural repair
  • safety protocol
  • surgical technique
  • patient safety

Footnotes

  • Disclosures and COI: The authors received no financial or material support, and have no conflict of interest. This manuscript has not been previously published, in whole or in part, or submitted elsewhere for review. Institutional Review Board approval is not required because this a retrospective review of outcomes using accepted treatment standards, thereby not meeting the criteria of “research.”

  • ©International Society for the Advancement of Spine Surgery
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Safe Discharge of Patients From an Ambulatory Care Center After Incidental Durotomy During Minimally Invasive Spine Surgery
Thomas L. Francavilla, Michael C. Weiss, Reginald Davis
International Journal of Spine Surgery Aug 2019, 6053; DOI: 10.14444/6053

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Safe Discharge of Patients From an Ambulatory Care Center After Incidental Durotomy During Minimally Invasive Spine Surgery
Thomas L. Francavilla, Michael C. Weiss, Reginald Davis
International Journal of Spine Surgery Aug 2019, 6053; DOI: 10.14444/6053
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Keywords

  • incidental durotomy
  • CSF leakage
  • minimally invasive spine surgery
  • ambulatory surgery
  • complications
  • dural repair
  • safety protocol
  • surgical technique
  • patient safety

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