Spinal Dural Repair: A Canadian Questionnaire.

Area of Science:

• Neurosurgery
• Spinal Surgery
• Surgical Complications

Background:

• Iatrogenic dural tears are a common complication of spinal surgery.
• These tears can lead to significant patient morbidity and increased healthcare costs.
• Optimal management strategies for iatrogenic dural tears remain unclear.

Purpose of the Study:

• To survey current practices among Canadian neurosurgical practitioners regarding the management of iatrogenic dural tears.
• To identify areas of consensus and disagreement in dural tear closure techniques.

Main Methods:

• An anonymous questionnaire was administered to members of the Canadian Neurological Surgical Society.
• The survey explored methods for closing iatrogenic durotomies of varying sizes and locations.
• A 55% response rate was achieved from 91 participating spinal surgeons.

Main Results:

• No consensus exists for closing pinhole-sized tears; sealant fixation is trending.
• Medium and large tears are primarily closed with sutures and sealant.
• Anterior tears are often managed without primary closure or with sealant alone; posterior tears favor sutures and sealant.
• Tisseal is the preferred sealant. Bed rest recommendations vary by tear size.

Conclusions:

• Significant uncertainty exists in managing iatrogenic dural tears, particularly anterior, nerve root, and pinhole-sized tears.
• Disagreement on patient management, including bed rest duration and hospital admission, was noted.
• There is a clear need for robust comparative research to establish evidence-based dural repair strategies.