Risk Factors for Accidental Dural Tears in Spinal Surgery

Background Accidental dural tears (DTs) are familiar complications of spinal surgery. Their reported incidence varies widely, and several risk factors have been proposed in the literature. The aim of this study was to conduct a systematic review and meta-analysis to determine the rate of DTs and assess their associated risk factors.

Methods A systematic literature search was conducted using specific MeSH and Text terms. Only articles with prospective data reporting the incidence and risk factors were selected and reviewed based on specific inclusion and exclusion criteria.

Results Twenty-three studies were included. The reported incidence rate ranged from 0.4% to 15.8%, giving an overall pooled incidence rate of 5.8% (95% confidence interval [CI] 4.4−7.3). The incidence rate varied in relation to the part of the spine and the type of surgery. Three factors were associated with a high rate of DTs: age (overall mean difference of 3.04, 95% CI 2.49−3.60), revision surgery (overall odds ratio of 2.28, 95% CI 1.84−2.83), and lumbar stenosis (overall odds ratio of 2.03, 95% CI 1.50−2.75). Diabetes was weakly associated with DTs, with an odds ratio of 1.40 (95% CI 1.01−1.93). The overall effects of sex and obesity were not statistically significant.

Conclusion Advancing age, revision surgery, and lumbar stenosis were significantly associated with increased risk of DTs. These factors should be taken into consideration during the consenting process for spinal surgery.

Clinical Relevance Risk of dural tear during spine surgery.