Spinal Dural Repair: A Canadian Questionnaire

Questionnaire.

Iatrogenic dural tear is a complication of spinal surgery with significant morbidity and cost to the health care system. The optimal management is unclear, and therefore we aimed to survey current practices among Canadian practitioners.

A questionnaire was administered to members of the Canadian Neurological Surgical Society designed to explore methods of closure of iatrogenic durotomy.

Spinal surgeons were surveyed anonymously with a 55% response rate (n = 91). For pinhole-sized tears, there is no agreement in the methods of closure, with a trend toward sealant fixation (36.7%). Medium- and large-sized tears are predominantly closed with sutures and sealant (67% and 80%, respectively). Anterior tears are managed without primary closure (40.2%), or using sealant alone (48%). Posterior tears are treated with a combination of sutures and sealant (73.8%). Nerve root tears are treated with either sealant alone (50%), or sutures and sealant (37.8%). Tisseal is the preferred sealant (79.7%) over alternatives. With the exception of pin-hole sized tears (39.5%) most respondents recommended bed rest for at least 24 hours in the setting of medium (73.2%) and large (89.1%) dural tears.

This study elucidates the areas of uncertainty with regard to iatrogenic dural tear management. There is disagreement regarding management of anterior and nerve root tears, pinhole-sized tears in any location of the spine, and whether patients should be admitted to hospital or should be on bed rest following a pinhole-sized dural tear. There is a need for a robust comparative research study of dural repair strategies.