Incidence, treatment and results in unintentional durotomy during

spinal surgeries performed by the department of neurosurgery,

Abbasi Shaheed Hospital Karachi; a two years review study.

Authors: Zafar Iqbal, Maroof Hashmi, Ghazanfar Tahir, Shahid Ahmed

Correspondence to Dr Zafar Iqbal: Department of Neurosurgery Abbasi Shaheed hospital,

Nazimabad, Karachi, Pakistan. Phone: +92-21-9260420-5 Cell: +92-300-3615547
E-mail: zafariqbaldr@gmail.com

Abstract
Background and purpose:
The dural tear, commonly named by the neurosurgeons as unintentional durotomy is not
uncommon in neurosurgical practice. This study compares the incidence, various modes
of treatment and results in surgical as well as non surgical treatment.
Methods:
We conducted a review of patients who had unintentional durotomy during spinal
surgeries performed by the department of neurosurgery, Abbasi Shaheed Hospital
Karachi during the period from January 2007 to December 2008. Among 107 patients
operated for various indications including lumbar disc herniation, spinal stenosis, and
spinal instability were evaluated regarding incidence, treatment and results in each
category. The variables are compared with international results and discussed in the
study. Out of 107 spinal surgery cases 8 had incidental dural tear. All were detected per
operatively and were repaired. All remained in hospital till the wound was satisfactorily
healed. One patient required prolonged stay of 3 weeks and required lumbar drain
placement. Others were treated by strict bed rest, Acetazolamide, nursing in prone
position and antibiotics. Patients were subsequently re-evaluated at regular intervals for
any persistent CSF leak.

Results:
In the 8 cases reviewed, all patients were discharged in a time frame comparable to that
of patients undergoing similar procedure in which no CSF leak was identified, or in
whom a CSF leak was identified and repaired at the same time. Only one patient required
prolonged stay of 3 weeks and required lumbar drain placement. No patients suffered
complications arising from prolonged drain presence. No patients suffered from
persistent CSF leak after drains were removed. It was more common in spinal stenosis,
re-do laminectomies and Cauda Equina syndrome with large central disc herniation.

Conclusions:
Primary closure of dural tear remains the standard of care. Furthermore, in select cases,
prolonged lumbar drainage in the setting of postoperative CSF leak may be a useful
technique for the treatment of these leaks. The 7% incidence of unintentional durotomy in
our department is not higher than the incidence in the world literature (4% -17%).

Keywords: incidental durotomy, dural tear, unintentional durotomy, CSF leak.