• Evangelos Kogias, Jan-Helge Klingler, Pamela Franco Jimenez, Ioannis Vasilikos, Ronen Sircar, Christoph Scholz, and Ulrich Hubbe.
• Department of Neurosurgery, University Medical Center Freiburg, Germany.
• J Spinal Disord Tech. 2015 Apr 20.

Study DesignRetrospective case-control study.ObjectiveTo compare the incidence, management and outcome of incidental durotomy in revision microdiscectomy with open and minimal-access surgery.Summary Of Background DataIncidental durotomy occurs with a variable incidence of 3-27% in spine surgery. The highest rate occurs in revision microdiscectomy. The intraoperative and postoperative management of dural tears varies in the literature and the definite impact on clinical outcome has to be clarified.MethodsRetrospective study of medical records of 135 patients that underwent revision microdiscectomy, divided into two subgroups: OPEN (n=82) versus minimal-access surgery (MINI, n=53). Occurrence of intraoperative dural tears, intra- and postoperative management of durotomy and clinical outcomes, according to MacNab criteria, were retrospectively examined. Statistical comparisons for categorical values between groups were accomplished using the two-tailed Fisher exact test. P-values <0.05 were considered to be statistically significant.ResultsThe incidence of durotomy in group OPEN was 19.5% (n=16/82) and in group MINI 17.0% (n=9/53) [P=0.822]. The majority of durotomies (23/25) were repaired with an absorbable fibrin sealant patch alone. Postoperative cerebrospinal fluid (CSF)-fistula occurred only in one case of the OPEN group and was treated with lumbar drainage without the need for a reoperation. Patients with durotomy of the MINI group tended to have better outcome compared to the OPEN group without being statistically significant.ConclusionsThe incidence of durotomy and postoperative CSF-fistula in lumbar revision microdiscectomy does not significantly differ between minimal-access and standard open procedures. The application of a fibrin sealant patch alone is an effective strategy for dural repair in revision lumbar microdiscectomy.

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