Elsevier

World Neurosurgery

Volume 134, February 2020, Pages e951-e955
World Neurosurgery

Original Article
Incidence and Implications of Incidental Durotomy in Transforaminal Endoscopic Spine Surgery: Case Series

https://doi.org/10.1016/j.wneu.2019.11.045Get rights and content

Objective

To evaluate the incidence and outcomes of incidental durotomy in transforaminal endoscopic spine surgery.

Methods

Transforaminal lumbar endoscopic procedures were performed by 2 surgeons in 907 patients over a period of 4 years from 2014 to 2018. Patient data were evaluated retrospectively in these patients with a minimum follow-up of 1 year.

Results

In 907 patients over 4 years there were 5 durotomies: 4 incidental and 1 intentional. The rate for incidental durotomy was therefore 0.4%. There were no adverse outcomes from the incidental durotomies, and only 1 patient noted a headache.

Conclusions

Incidental durotomy is a rare complication of transforaminal lumbar endoscopic spine surgery and appears to occur more likely in patients who have undergone previous spine surgery at the site of the endoscopic procedure, not unexpectantly. Glues, patches, and bedrest were among the various methods used after durotomy. In this series there were no cases of symptomatic spinal fluid leakage or pseudomeningocele seen. Only 20% of patients who had durotomies noted a headache in the immediate postoperative period.

Introduction

Dural tears in lumbar spine surgery represent a significant morbidity to patients: incomplete surgeries, arachnoiditis, repeat surgeries, meningitis, headache, fistula, and even subarachnoid hemorrhage and subdural hemorrhage. Reports of the incidence of durotomy in lumbar spine surgery range from 1%−17% and with the incidence generally depending on the complexity of the surgery.1, 2, 3, 4 In microendoscopic spine surgery, a minimally invasive spine surgery performed through a tubular retractor, the incidence has been reported to be between 0% and 8.7%.5, 6, 7 In fully endoscopic spine surgery performed through a working channel endoscope, a multiinstitutional study reported an incidence of unintended durotomy of 0.54%.8 Here we examine a larger patient series focusing only on the incidence, implications, and treatment strategies for unintended durotomy in transforaminal endoscopic spine surgery.

Section snippets

Materials and Methods

This study is a retrospective chart review of 907 patients operated on by 2 surgeons between 2014 and 2018 with a minimum follow-up of 1 year. All surgical documentation for each patient was reviewed in this retrospective review. The focus of this study is on the incidence, implication, and treatment of incidental durotomy in endoscopic lumbar spine surgery. Patient follow-up was at 2 weeks, 6 weeks, 3 months, and 1 year after surgery. Endoscopic lumbar procedures in this series included only

Results

Patient data are summarized in Table 1. There were incidental durotomies encountered in 4 patients. All cases with incidental durotomies occurred in patients who had previous lumbar spine surgeries at the levels treated endoscopically.

Two patients had previous lumbar laminectomy and diskectomy procedures. In these cases, transforaminal endoscopic diskectomy procedures were performed for recurrent herniated disks. In both cases, nerve root sleeve tears could be seen along the traversing nerve

Discussion

Durotomy represents a significant morbidity to patients who undergo lumbar spine surgery and has a significant economic impact on delivery of spine care.9 The series published here is the largest series of transforaminal endoscopic spine surgery cases to examine the incidence and implications for durotomy in endoscopic spine surgery. The incidence of 0.4% is low and very much concordant with the incidence of 0.54% reported in the multicenter endoscopic spine surgery group publication on the

References (13)

There are more references available in the full text version of this article.

Cited by (16)

View all citing articles on Scopus

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

View full text