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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 thespinal 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.
A report published in the March 2016 journalClinical Neurology and Neurosurgeryfound that dural tears were more common among people who experienced poor outcomes from spine surgery in which asynovial cystwas 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, orkyphosis.
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.
Treatments for dural tears include bed rest, ablood patch, and if the leaking continues, surgical repair.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fang, Z.,Treatment of Cerebrospinal Fluid Lead After Spine Surgery. Chin J Traumatol. April 2017. doi:10.1016/j.cjtee.2016.12.002Klessinger S.The incidence of dural tears after complete resection of lumbar synovial cysts and the relation to the outcome. Clin Neurol Neurosurg. 2016;144:14-9. doi:10.1016/j.clineuro.2016.02.038Yao R, Zhou H, Choma TJ, Kwon BK, Street J.Surgical Site Infection in Spine Surgery: Who Is at Risk?. Global Spine J. 2018;8(4 Suppl):5S-30S. doi:10.1177/2192568218799056Aspalter S, Senker W, Radl C, Aichholzer M, Aufschnaiter-Hießböck K, Leitner C, Stroh N, Trutschnig W, Gruber A, Stefanits H.Accidental dural tears in minimally invasive spinal surgery for degenerative lumbar spine disease.Front Surg.2021 Jul 20;8:708243. doi:10.3389/fsurg.2021.708243Erdoğan U, Akpinar A.Clinical outcomes of incidental dural tears during lumbar microdiscectomy.Cureus.2021 Apr 8;13(4):e14360. doi:10.7759/cureus.14360Müller SJ, Burkhardt BW, Oertel JM.Management of dural tears in endoscopic lumbar spinal surgery: A review of the literature.World Neurosurg. 2018 Nov;119:494-499. doi:10.1016/j.wneu.2018.05.251
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fang, Z.,Treatment of Cerebrospinal Fluid Lead After Spine Surgery. Chin J Traumatol. April 2017. doi:10.1016/j.cjtee.2016.12.002Klessinger S.The incidence of dural tears after complete resection of lumbar synovial cysts and the relation to the outcome. Clin Neurol Neurosurg. 2016;144:14-9. doi:10.1016/j.clineuro.2016.02.038Yao R, Zhou H, Choma TJ, Kwon BK, Street J.Surgical Site Infection in Spine Surgery: Who Is at Risk?. Global Spine J. 2018;8(4 Suppl):5S-30S. doi:10.1177/2192568218799056Aspalter S, Senker W, Radl C, Aichholzer M, Aufschnaiter-Hießböck K, Leitner C, Stroh N, Trutschnig W, Gruber A, Stefanits H.Accidental dural tears in minimally invasive spinal surgery for degenerative lumbar spine disease.Front Surg.2021 Jul 20;8:708243. doi:10.3389/fsurg.2021.708243Erdoğan U, Akpinar A.Clinical outcomes of incidental dural tears during lumbar microdiscectomy.Cureus.2021 Apr 8;13(4):e14360. doi:10.7759/cureus.14360Müller SJ, Burkhardt BW, Oertel JM.Management of dural tears in endoscopic lumbar spinal surgery: A review of the literature.World Neurosurg. 2018 Nov;119:494-499. doi:10.1016/j.wneu.2018.05.251
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Fang, Z.,Treatment of Cerebrospinal Fluid Lead After Spine Surgery. Chin J Traumatol. April 2017. doi:10.1016/j.cjtee.2016.12.002Klessinger S.The incidence of dural tears after complete resection of lumbar synovial cysts and the relation to the outcome. Clin Neurol Neurosurg. 2016;144:14-9. doi:10.1016/j.clineuro.2016.02.038Yao R, Zhou H, Choma TJ, Kwon BK, Street J.Surgical Site Infection in Spine Surgery: Who Is at Risk?. Global Spine J. 2018;8(4 Suppl):5S-30S. doi:10.1177/2192568218799056Aspalter S, Senker W, Radl C, Aichholzer M, Aufschnaiter-Hießböck K, Leitner C, Stroh N, Trutschnig W, Gruber A, Stefanits H.Accidental dural tears in minimally invasive spinal surgery for degenerative lumbar spine disease.Front Surg.2021 Jul 20;8:708243. doi:10.3389/fsurg.2021.708243Erdoğan U, Akpinar A.Clinical outcomes of incidental dural tears during lumbar microdiscectomy.Cureus.2021 Apr 8;13(4):e14360. doi:10.7759/cureus.14360Müller SJ, Burkhardt BW, Oertel JM.Management of dural tears in endoscopic lumbar spinal surgery: A review of the literature.World Neurosurg. 2018 Nov;119:494-499. doi:10.1016/j.wneu.2018.05.251
Fang, Z.,Treatment of Cerebrospinal Fluid Lead After Spine Surgery. Chin J Traumatol. April 2017. doi:10.1016/j.cjtee.2016.12.002
Klessinger S.The incidence of dural tears after complete resection of lumbar synovial cysts and the relation to the outcome. Clin Neurol Neurosurg. 2016;144:14-9. doi:10.1016/j.clineuro.2016.02.038
Yao R, Zhou H, Choma TJ, Kwon BK, Street J.Surgical Site Infection in Spine Surgery: Who Is at Risk?. Global Spine J. 2018;8(4 Suppl):5S-30S. doi:10.1177/2192568218799056
Aspalter S, Senker W, Radl C, Aichholzer M, Aufschnaiter-Hießböck K, Leitner C, Stroh N, Trutschnig W, Gruber A, Stefanits H.Accidental dural tears in minimally invasive spinal surgery for degenerative lumbar spine disease.Front Surg.2021 Jul 20;8:708243. doi:10.3389/fsurg.2021.708243
Erdoğan U, Akpinar A.Clinical outcomes of incidental dural tears during lumbar microdiscectomy.Cureus.2021 Apr 8;13(4):e14360. doi:10.7759/cureus.14360
Müller SJ, Burkhardt BW, Oertel JM.Management of dural tears in endoscopic lumbar spinal surgery: A review of the literature.World Neurosurg. 2018 Nov;119:494-499. doi:10.1016/j.wneu.2018.05.251
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