Incidental durotomy in spine surgery: first aid in ten steps

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Luca PapaveroRalph Kothe

Abstract

Incidental durotomy (ID) is the most common complication of spine surgery. Revision procedures, ossification of the yellow ligament, or synovial cysts are well-known risk factors. The size, shape, and severity of ID are unpredictable, ranging from a pinpoint hole to a several centimeters large dural laceration with transected fibers following the slippage of a cutting burr. Furthermore, the occurrence of ID is always unexpected. Intra-operative management is often based on a steep learning curve rather than a structured scheme. To provide an intra-operative ten-step closure technique (10ST) for IDs of varying severity. A database of 4020 consecutive surgeries for lumbar degenerative disease over the past 4 years was searched for ID. The records of 176 patients were analyzed. Two dural repair techniques were compared: the "individual" technique (InT) and the 10ST. The overall prevalence of ID was 4.4%. The prevalence was lowest in virgin micro-discectomies (1.7%) and ranged from 3.6% in decompression for spinal canal stenosis up to 14.5% in revision procedures. All surgeries were performed with the aid of a microscope. Among 107 primary surgeries, the InT achieved a single-stage closure of the ID in 96 procedures (89.7%). Among ...Continue Reading

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Citations

Jan 7, 2016·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Robert C Mulholland
Dec 25, 2015·World Neurosurgery·Maria KamenovaJehuda Soleman
Mar 22, 2016·The Spine Journal : Official Journal of the North American Spine Society·Philip Sell
Apr 30, 2016·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Ralph KotheC Siepe
Dec 3, 2016·Neurological Research·Meghan E MurphyMohamad Bydon
Sep 26, 2019·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Mazda FarshadDavid Ephraim Bauer
Sep 13, 2019·Spine·Ram AlluriRaymond J Hah
May 24, 2018·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Jong Ki ShinJung Sub Lee
Jan 22, 2020·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Pedro BerjanoStefano Boriani
Sep 17, 2017·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Wolfgang Börm
Jul 22, 2019·Operative Orthopädie und Traumatologie·L Papavero, R Kothe
Apr 17, 2020·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Zeiad A F AlshameeriVinay Jasani
Feb 5, 2021·The Journal of the American Academy of Orthopaedic Surgeons·Hamid HassanzadehVarun Puvanesarajah
Jul 23, 2021·Frontiers in Surgery·Kartik ShenoySrinivas K Prasad
Jan 7, 2022·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Ole Kristian AlhaugGreger Lønne

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