Ghulam Farooq, Alimuddine Shaikh, Aorangzeb, Alishah, Senella Altaf.
Incidental dural tears during lumbar spine surgery: Risk factors, Location, incidence, complications, treatment and clinical outcome.
Pak J Surg Jan ;29(3):205-10.

Objective: To analyze the risk factors, location, incidence, complications, treatment and clinical outcome of unintended dural tears during lumbar spine surgery. Study design: Retrospective review of 200 patients who underwent lumbar spine surgery at Department of Neurosurgery Jinnah Post Graduate Medical Center during 4 years period from 2009 to 2012. Methods: A total of 200 patients who underwent spine surgery were selected for this analysis. Patients in whom dura was intentionally opened for tumors and those whose dura was teared by trauma were excluded from this study. Patients with revision surgery and cystic lesions around facet joints that caused dural tears were also excluded from the study. Th e treatment of the dural tear was reviewed from the operative notes. Results: 14 (7%) dural tears were recognized in this study. Th e mean age of the patients with dural tear and those without dural tear was 64 and 53 years respectively. Th is age diff erence was statistically signifi cant. Th e incidence of dural tears in male (118) and female (82) was 4% (5 of 118) and 11% (9 of 82) respectively, also a signifi cant fi nding. Th ere was no signifi - cant association between dural tears and type of procedure performed. In relation to diseases associated with incidental dural tears, the incidence of dural tear was 25 % (6 of 24 disc level treated) in degenerative spondylolisthesis with element of canal stenosis .Th is was signifi - cantly high association. While none of the disc spaces treated was signifi cantly associated with dural tears. Dural tears were recognized during surgery in all cases and were repaired primarily with 6-0 proline.No complications related to dural tear was reported during 18 months of follow up.JOA scoring system was utilized to assess the clinical outcome at 18 months that showed good outcome in both groups. Conclusion: Dural tears during spine surgery are not uncommon. Elderly female with degenerative spondylolisthesis with canal stenosis is high risk population for dural tear during spinal surgery according to Author’s fi nding. Such patients should be told the possibility of dural tear and its management before the intended procedure.

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