Management of iatrogenic dural tears in the lumbar spine surgery

Thirty two patients with iatrogenic dural tears were reported out of 260 patients of lumbar spine surgery [12.3 percent] who were operated upon at Orthopedic Department, Assiut University Hospitals from 1990 to 1997. The operation was done for spinal canal stenosis in 120 patients [46.2 percent], 80 were recurrent disc prolapse or post laminectomy syndrome [30.8 percent], and 25 were single or multiple level fresh disc herniation [9.6 percent] and 35 patients with Spondylolithesis [13.5 percent]. The tear was posterior in 21 patients [65.6 percent] and posterolateral in 9 [28.1 percent] and ventral in 2 patients [6.2 percent] The tear was repaired primarily in 27 patients [84.4 percent], covered by fascial flap and gelfoam layer due to inaccessible tear in 5 patients [15.6 percent]. Postoperative complete bed rest in prone position was obligatory in all patients in a position depending on the site of tear. The patients were followed up for one year at least. 17 were males [53.1 percent] and 15 were females [46.9 percent]. Twenty seven patients [84.4 percent] showed excellent results, 4 patients [12.5 percent] showed fair results [one patient with closed pseudomeningocele, three with persistent CSF leakage, where two of them were treated by re-operation and the third improved after a longer duration of complete bed rest]. One patient [3.1 percent] with poor result [severe meningitis and neurological deterioration]. All the patients with fair or poor results were not repaired by direct primary repair. We conclude that primary repair is obligatory in all patients with iatrogenic dural tears. The incidence of dural tears is higher in recurrent patient than in any other lumbar spine surgery