Dural Sac Tears During Spinal Surgery

An accidental dural tear is a potential complication of spine surgery. This occurs when the thin covering over the spinal cord (called meninges) is nicked by the surgical instrument. While most dural tears are repaired and heal, in rare instances, they can lead to cerebrospinal fluid (CSF) leakage, meningitis, nerve problems, and more serious conditions, as well.

Surgeons in an operating room
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Types of Spine Surgery That May Cause a Dural Sac Tear

Spine surgery and spinal cord surgery can cause a dural tear for a number of reasons. The dura is a thin layer of tissue that covers and protects the spinal cord. It lies in between the spine (the bone) and the spinal cord (nerve tissue). Durotomy, which is an incision in the dura, can be a planned part of the surgical technique.

Incidental durotomy, also described as an accidental dural tear, can happen during spine surgery or spinal cord surgery as well.

  • Disc surgery and single-level decompression surgeries have a relatively low risk of dural tears.
  • Dural tears tend to occur most frequently with revision spine surgery, multi-level spine surgery, spinal fusion, and multi-level decompression for spinal stenosis.

A report published in the March 2016 journal Clinical Neurology and Neurosurgery found that dural tears were more common among people who experienced poor outcomes from spine surgery in which a synovial cyst was removed and that when only part of the cyst is removed, the patient is at lower risk for a dural tear.  The authors also say that dural tears tend to happen most often at the level L5/S1.

Preventing Dural Tears

Pre-existing conditions and/or deformities can increase your risk of a dural tear. For example, using steroids, having diabetes, or being a smoker all increase your risk. The risk is also increased if you have spondylolisthesis, spinal stenosis, scoliosis, or kyphosis.

Sometimes minimally invasive procedures might have a lower risk of dural teat than more invasive surgeries, although this is not always the case.

Even with the most skilled surgeon and well-planned technique, there is a risk of a dural sac tear in any spinal surgery. The membrane that covers the spinal cord is not hardy like bone, skin, or muscle, Dr. Joshua D. Auerbach, Chief of Spine Surgery at Bronx-Lebanon Hospital Center in New York City, tells me. “It’s delicate and easily torn.”

Incidence

Dural tears are not uncommon. The incidence rates reported in research studies vary widely. There is a range in the risk of this complication, depending on the type of surgery and why it is done.

In one fairly large study, for example, of 5,476 patients who had surgery for primary single-level lumbar disc herniation, 192 patients (2.85%) experienced a dural tear. And a large review found an incidence ranging from 0 to 8.6%, with the highest incidence after synovial cyst removal or bilateral decompression procedures that used a unilateral approach.

Symptoms and Treatment

A cerebrospinal fluid leakage (called CSF leak) is one of the most common effects of a dural tear.

Dr. Auerbach says if you have a CSF leak, you may notice a clear fluid discharging from your surgical wound.

But the leak might remain deep near your spine. It often doesn't reach the wound, so it's usually not visible.

You may experience position-related headaches that get worse when you stand up and are relieved when you lie down. Other symptoms include visual changes, nausea, vomiting, or dizziness, Auerbach says.

If it's not treated quickly and properly, a CSF leak can be dangerous. That said, a dural tear is usually caught by your healthcare provider during surgery and is treated right then and there. And if it is not detected during surgery, the signs and symptoms are detected during the postoperative period when your healthcare providers check on you.

Treatments for dural tears include bed rest, a blood patch, and if the leaking continues, surgical repair.

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6 Sources
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