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Incidental durotomy in lumbar spine surgery: incidence and management

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Abstract

There is increasing awareness of the need to inform patients of common complications that occur during surgical procedures. During lumbar spine surgery, incidental tear of the dural sac and subsequent cerebrospinal fluid leak is possibly the most frequently occurring complication. There is no consensus in the literature about the rate of dural tears in spine surgery. We have undertaken this study to evaluate the incidence of dural tears among spine surgeons in the United Kingdom for commonly performed spinal procedures. Prospective data was gathered for 1,549 cases across 14 institutions in the United Kingdom. The results give us a baseline rate for the incidence of dural tears. The rate was 3.5% for primary discectomy, 8.5% for spinal stenosis surgery and 13.2% for revision discectomy. There was a wide variation in the actual and estimated rates of dural tears among the spine surgeons. The results confirm that prospective data collection by spine surgeons is the most efficient and accurate way to assess complication rates for spinal surgery.

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Authors and Affiliations

  1. Leicester General Hospital, University Hospitals Leicester, Leicester, UK

    Suhayl I Tafazal & Philip J Sell

Authors
  1. Suhayl I Tafazal
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  2. Philip J Sell
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Corresponding author

Correspondence to Suhayl I Tafazal.

Additional information

This research was carried out at the Leicester General Hospital, Leicester, UK.

Appendices

Appendix

BRITISH ASSOCIATION OF SPINE SURGEONS

AUDIT OF DURAL TEARS 2002

Discectomy - Revision Discectomy - Spinal Stenosis

Please complete this audit sheet to the best of your ability. The accuracy of data is important but we recognise that not everyone has a database for easy recall. A dural tear is where there is free CSF seen, or a dural leak is subsequently apparent. Comments would be helpful and the way you deal with them would also be of interest.

NAME ..................................... HOSPITAL ..........................................

Neurosurgeon/Orthopaedic surgeon (delete as applicable)

Primary discectomy

Number of index cases ....... No. of dural tears .......

Do you use a microscope for these? YES/NO

Revision discectomy

Number of index cases ....... No. of dural tears .......

Spinal stenosis

Number of index cases ....... No. of dural tears ......

These figures are accurate as I keep a prospective database YES/NO

These figures are estimates of numbers of cases carried out YES/NO

I have guessed as I have no way of recording what occurs YES/NO

My method of dealing with a dural tear is as follows: (please include type of suture material, drain or not, bed-rest or not, antibiotics and mobilisation plan)

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Return to Philip Sell, BASS, Department of Orthopaedics, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW

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Tafazal, S.I., Sell, P.J. Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J 14, 287–290 (2005). https://doi.org/10.1007/s00586-004-0821-2

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  • DOI: https://doi.org/10.1007/s00586-004-0821-2

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