Management of Dural Tears in Spine Surgery: A Worldwide Survey of Current Practices and Complications

Study Design Cross-sectional survey. Objectives To determine the prevalence and predictors of incidental durotomy (ID) among AO Spine surgeons globally, and assess current management strategies and associated complications. Methods An electronic questionnaire was distributed to 937 AO Spine surgeon members in October-November 2024, to collect data on surgeon demographics, work characteristics, experience with ID, and preferred management techniques. Logistic regression identified predictors of frequent IDs (>5% of surgeries). Significance was set at P ≤ 0.05. Results Surgeons reported ID frequencies ranging from 1% to >20%. Overall, 12% reported frequent IDs. Longer surgical experience (OR = 0.406, P = 0.031) was protective, while working in a public/ governmental hospital (OR = 1.775, P = 0.023) was a risk factor. Medium-sized IDs (1-10 mm) were most common in lumbar surgery (52.2%). Sutures and sealants were commonly used for medium and large tears. Prolene sutures (76.5%) and autologous grafts (53.8%) were preferred. Subfascial drains without suction were frequently used. Management of large and medium tears commonly included 48 and 24 hours of bed rest, respectively. Immediate ambulation was most frequent for small tears. Most surgeons (79.2%) reported occasional or rare complications from dural tears, with a significant association with dural graft repair (OR = 1.946, P < 0.001). Disclosure of IDs to patients was nearly universal (97.3%). Conclusion The study highlights the frequency with which incidental durotomy occurs globally during spinal surgery. Longer surgical experience was a protective factor of frequent ID, while working in a public/ governmental hospital was a risk factor. Standardized protocols for small tears or guidelines for deciding between repair and non-repair are recommended.