Study Design : A retrospective study.
Objective : To analyze the clinical features and prognosis of intraoperative incidental durotomy during posterior surgery for 3egenerative lumbar disease. In addition, we tried to evaluate clinical outcome and safety of skillful neglect of pin point dural tear. Summary of literature review : Incidental durotomy is one of the most common complications during the operation of degeneritive lumbar disease. It may cause signs and symptoms of cerebrospinal fluid leakage and complications such as meningitis,
Around infection, pseudomeningocele and fistula. From the literature review, primary repair is mandatory even in the case of pin Joint dural tear.
Materials and methods : Seven hundred fifty-five patients with degenerative lumbar disease, who were operated posteriorly I rom Jan. 1990 to Feb. 2002, were reviewed retrospectively. Primary operations were 378 cases of laminectomy without instrui lentation and 377 cases of decompression and instrumented fusion. Of these patients, 44 (6 percent) sustained an incidental c ural tear.
Ve analyzed the mechanisms of dural tear, intraoperative treatment, postoperative management and clinical outcome.
Lesults : Eight cases (2.1%) of dural tears occurred during discectomy, 36 (95%) during instrumentation and fusion, and 12 (20%) during revision surgery. Dural tears were treated intraoperatively by primary repair in 20 cases, by fascial graft in 2 and with - c.tt repair (skillful neglect) in 22. There were no cases of persistent cerebrospinal fluid leakage or fistula formation, and the :: ~mptoms of cerebrospinal fluid leakage were transient. Of 36 patients followed for more than one year, 82% had good or e ccellent result.
Conclusion : Incidental durotomy occurred in 5.8 percent of lower back surgery patients, and more frequently in revision surgery. Very small dural tears did not have significant influence on the clinical outcome, whether they were repaired or not. S J11ful neglect of pin point ducal tear may be a reasonable treatment option.
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