Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts

Background: Although dural tears (DTs) are known potential intraoperative complications of spine surgery, there is a relative lack of information about the true incidence of this common occurrence. Various studies have reported incidences ranging from 1.6%-17.4%. The literature on iatrogenic DT during spine surgery is surprisingly sparse; and the management is controversial. Purpose: To evaluate the use of lumbar drain and fat graft following incidental durotomy in prevention of early CSF leak and pseudomeningocele formation later on. Study Design: Prospective clinical case study. Patients and Methods: 343 patients were included in this study with degenerative spinal diseases indicated for decompression (lumbar disc, canal stenosis, degenerative spondylolisthesis or revision surgery). We excluded trauma cases and ventral tears not repaired. Patients with incidental dural tear had direct primary closure and then patients were divided into two groups: group A; a lumbar drains were inserted, and group B; a fat graft was used without drain. Both groups were followed-up for CSF leak control and pseudomeningocele formation. Results: We had 38 patients with DTs from 343 patients undergoing lumbar surgery with incidence of (11%). High incidence of DT occurred in revision surgeries (21.8%). In group (A), 85% of cases were free, 15% showed transient CSF leak managed conservatively, while in group (B), 72.2% were free, 27.7% showed transient CSF leak and 16.6% required repair for pseudomeningocele later on. Conclusion: Incidental durotomy is a well-known complication of spine surgery, and it occurs even among experienced spine surgeons. The use of lumbar drain was more efficient than fat graft in minimizing the postoperative CSF leak and pseudomeningocele formation. (2015ESJ078