Risk Factors for Accidental Dural Tears in Spinal Surgery.

BACKGROUND: Accidental dural tears (DTs) are familiar complications of spinal surgery. Their reported incidence varies widely, and several risk factors have been proposed in the literature. The aim of this study was to conduct a systematic review and meta-analysis to determine the rate of DTs and assess their associated risk factors. METHODS: A systematic literature search was conducted using specific MeSH and Text terms. Only articles with prospective data reporting the incidence and risk factors were selected and reviewed based on specific inclusion and exclusion criteria. RESULTS: Twenty-three studies were included. The reported incidence rate ranged from 0.4% to 15.8%, giving an overall pooled incidence rate of 5.8% (95% confidence interval [CI] 4.4-7.3). The incidence rate varied in relation to the part of the spine and the type of surgery. Three factors were associated with a high rate of DTs: age (overall mean difference of 3.04, 95% CI 2.49-3.60), revision surgery (overall odds ratio of 2.28, 95% CI 1.84-2.83), and lumbar stenosis (overall odds ratio of 2.03, 95% CI 1.50-2.75). Diabetes was weakly associated with DTs, with an odds ratio of 1.40 (95% CI 1.01-1.93). The overall effects of sex and obesity were not statistically significant. CONCLUSION: Advancing age, revision surgery, and lumbar stenosis were significantly associated with increased risk of DTs. These factors should be taken into consideration during the consenting process for spinal surgery. CLINICAL RELEVANCE: Risk of dural tear during spine surgery.

Clinical Outcome of Spine Surgery Complicated by Accidental Dural Tears: Meta-Analysis of the Literature.

STUDY DESIGN: Systemic review and meta-analysis. OBJECTIVES: Several studies have reported the impact of accidental dural tears (DT) on the outcome of spinal surgery, some with conflicting results. Therefore, the aim of this study was to carry out a systemic review and meta-analysis of the literature to establish the overall clinical outcome of spinal surgery following accidental DT. METHOD: A systemic literature search was carried out. Postoperative improvement in Oswestry Disability Index (ODI), Short-Form 36 survey (SF36), leg pain visual analogue scale (VAS), and back pain VAS were compared between patients with and without DT at different time intervals. RESULTS: Eleven studies were included in this meta-analysis. There was a slightly better improvement in ODI and leg VAS score (standardized mean difference of -0.06, 95% confidence interval [CI] -0.12 to -0.01, and -0.06, 95% CI -0.09 to -0.02, respectively) in patients without DT at 12 months postsurgery, but this effect was not demonstrated at any other time intervals up to 4 years. There were no differences in the overall SF36 (function) score at any time interval or back pain VAS at 12 months. CONCLUSION: Based on this study, accidental DT did not have an overall significant adverse impact on the short-term clinical outcome of spinal surgery. More studies are needed to address the long-term impact and other outcome measures including other immediate complications of DT.

A systematic review and meta-analysis on the management of accidental dural tears in spinal surgery: drowning in information but thirsty for a clear message.

PURPOSE: To systematically review the published techniques for dural tear (DT) repair in spinal surgery to determine the repair method associated with the lowest failure rate. METHOD: A systematic literature search was conducted. Studies reporting the treatment of accidental DT in elective spinal surgery were selected and reviewed with regards to the incidence of DT, repair techniques and outcome. Meta-analysis of proportions was used to compare the outcome of different repair techniques and their adjuncts. RESULTS: Forty-nine studies were included with a total of 3822 DT cases. The outcome of different dural repair techniques was available for 2329(60.9%) cases. The overall pooled risk of DT was 0.052(0.040-0.065) and the overall pooled proportion of failed DT treatment regardless of the treatment method was 0.061(0.044-0.083). The proportion of failure varied according to the repair method. The overall proportion of failure following direct repair with suture (with or without any other augment) was lower than indirect repair (with sealant and or patch): 0.037 (0.024-0.053) versus 0.047 (0.026-0.074), respectively. Bed rest and the use of sub-fascial drain were not associated with improved outcome according to our results. CONCLUSION: Direct repair was associated with low proportion of failure. Howver, the approach to DT treatment was commonly determined on an ad hoc basis according to surgeons' preferences, and few followed defined management protocols. Future studies reporting DT treatment ought to categorise the treatment outcome according to the complexity of the DT and the specific treatment used, thus improving research quality in the field.