Original ArticleIncidence and Implications of Incidental Durotomy in Transforaminal Endoscopic Spine Surgery: Case Series
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
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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.