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. 2024 Sep;21(3):756-766.
doi: 10.14245/ns.2448346.173. Epub 2024 Sep 30.

Intraoperative Management of Iatrogenic Durotomy in Endoscopic Spine Surgery: A Systematic Review

Warayos Trathitephun  1 , Akarawit Asawasaksakul  2 , Khananut Jaruwanneechai  3 , Boonserm Pakdeenit  4 , Abhirat Suebsing  3 , Yanting Liu  5 , Jin-Sung Kim  5 , Siravich Suvithayasiri  1   6
Affiliations

Intraoperative Management of Iatrogenic Durotomy in Endoscopic Spine Surgery: A Systematic Review

Warayos Trathitephun et al. Neurospine. 2024 Sep.

Abstract

This review aims to systematically evaluate the incidence, management strategies, and clinical outcomes of iatrogenic durotomy (ID) in endoscopic spine surgery and to propose a management flowchart based on the tear size and associated complications. A comprehensive literature search was conducted, focusing on studies involving endoscopic spinal procedures and incidental durotomy. The selected studies were analyzed for management techniques and outcomes, particularly in relation to the size of the dural tear and the presence of nerve root herniation. Based on these findings, a flowchart for intraoperative management was developed. A total of 14 studies were included, encompassing 68,546 patients. Varying incidences of ID, with management strategies largely dependent on the size of the dural tear, were found. Small tears (less than 5 mm) were often left untreated or managed with absorbable hemostatic agents, while medium (5-10 mm) and large tears (greater than 10 mm) required more complex approaches like endoscopic patch repair or open surgery. The presence of nerve root herniation necessitated immediate action, often influencing the decision to convert to open repair. Effective management of ID in endoscopic spine surgery requires a nuanced approach tailored to the size of the tear and specific intraoperative challenges, such as nerve root herniation. The proposed flowchart offers a structured approach to these complexities, potentially enhancing clinical outcomes and reducing complication rates. Future research with more rigorous methodologies is necessary to refine these management strategies further and broaden the applications of endoscopic spine surgery.

Keywords: Complication; Dura tear; Dural injury; Iatrogenic durotomy; Management; Surgical technique; Systematic review.

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Conflict of interest statement

Conflict of Interest

The authors have nothing to disclose.

Figures

Fig. 1.
Fig. 1.
Flowchart diagram demonstrating the articles included in this systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) 2020 guideline.
Fig. 2.
Fig. 2.
Graphic visualization showing the assessment of the risk of bias among the included studies using the ROBINS-E (Risk Of Bias In Non-randomized Studies–of Exposure) tool.
Fig. 3.
Fig. 3.
A proposed strategic management flowchart for iatrogenic durotomy during endoscopic spine surgery.
See this image and copyright information in PMC

Comment in

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