Postoperative management of incidental durotomy in minimally invasive lumbar spinal surgery

Unintended durotomy is a relatively common complication in spine surgery, with a reported incidence up to 14%. Traditional management has been mandatory bed rest for at least 48 h following repair, with or without placement of a drain. With the muscle-splitting approach and decreased potential (dead) space created during minimally invasive spinal surgery (MISS), there is less potential likelihood of symptoms such as spinal headaches or cerebrospinal fluid fistulas. We reviewed the cases of 5 patients undergoing lumbar MISS complicated by an incidental dural tear. Surgical treatment consisted of primary repair and/or use of DuraGen followed by application of either DuraSeal or Tisseel. Although the duration of bed rest varied, postoperative management involved early mobilization less than 48 h after surgery without the use of a drain. One patient was mobilized early on the second postoperative day, 2 patients were mobilized the morning after surgery, and 2 patients were mobilized immediately upon recovery from anesthesia. None of the patients developed symptoms related to durotomy. Although this represents a small series, early postoperative mobilization appears to be a reasonable option and results in shorter hospitalization.