Investigation of Orthopaedic Surgery Resident Education Regarding the Management of Unintentional Durotomies

Unintentional durotomies occur in 2% to 5% of spine surgeries and in 20% of patients with spinal trauma. While neurosurgeons have historically managed intradural pathology, it is critical that all spine surgeons receive adequate training in the intraoperative and postoperative management of durotomies. Previous literature indicates notable interprogram heterogeneity regarding the quality of spinal surgery experience orthopaedic residents receive in their residency programs, however. To our knowledge, no study has previously studied orthopaedic resident education and experience regarding the management of unintentional durotomies. The purpose of this study was to evaluate resident education with management of unintentional durotomies in spine surgery.

This study was an anonymous eight-question survey sent to all 207 accredited orthopaedic residency programs investigating resident experience with the intraoperative and postoperative management of unintentional durotomies.

Two hundred thirty-one residents responded to the survey, with 43.7% being senior residents (PGY4-5). Of the 231 respondents, 28.1% (65/231) reported feeling comfortable with the intraoperative management of durotomies. Regarding primary suture repair, 2.6% (6/231) stated that they have completed the procedure as lead surgeon, with 62.8% (145/231) having assisted an attending. 34.6% (80/231) of residents reported having never seen a suture repair. Regarding fibrin glue or muscle patch, 7.4% (17/231) reported performing the procedure as lead surgeon, with 48.1% (111/231) having partially completed or assisted ( Figure 2 ). 44.6% (103/231) reported having never seen a patch repair. Of the 231, 52.8% (122/231) reported feeling comfortable with postoperative management of unintentional durotomies. 37.2% (86/231) stated that they do not feel comfortable managing lumbar drains. 59.7% (138/231) believed that they would benefit from additional experience during training.

Unintentional durotomies occur frequently with notable morbidity. In this survey study of all accredited orthopaedic programs, residents reported limited experience with the management of unintentional durotomies with most reporting that they would benefit from additional experience during training.