{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:06:34Z","timestamp":1792631194094,"version":"4.5.0"},"reference-count":92,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECT<\/jats:title>\n                    <jats:p>Unintended durotomy is a common occurrence during lumbar spinal surgery, particularly in surgery for degenerative spinal conditions, with the reported incidence rate ranging from 0.3% to 35%. The authors performed a systematic literature review on unintended lumbar spine durotomy, specifically aiming to identify the incidence of durotomy during spinal surgery for lumbar degenerative conditions. In addition, the authors analyzed the incidence of durotomy when minimally invasive surgical approaches were used as compared with that following a traditional midline open approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A MEDLINE search using the term \u201clumbar durotomy\u201d (under the 2015 medical subject heading [MeSH] \u201ccerebrospinal fluid leak\u201d) was conducted on May 13, 2015, for English-language medical literature published in the period from January 1, 2005, to May 13, 2015. The resulting papers were categorized into 3 groups: 1) those that evaluated unintended durotomy rates during open-approach lumbar spinal surgery, 2) those that evaluated unintended durotomy rates during minimally invasive spine surgery (MISS), and 3) those that evaluated durotomy rates in comparable cohorts undergoing MISS versus open-approach lumbar procedures for similar lumbar pathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The MEDLINE search yielded 116 results. A review of titles produced 22 potentially relevant studies that described open surgical procedures. After a thorough review of individual papers, 19 studies (comprising 15,965 patients) pertaining to durotomy rates during open-approach lumbar surgery were included for analysis. Using the Oxford Centre for Evidence-Based Medicine (CEBM) ranking criteria, there were 7 Level 3 prospective studies and 12 Level 4 retrospective studies. In addition, the authors also included 6 studies (with a total of 1334 patients) that detailed rates of durotomy during minimally invasive surgery for lumbar degenerative disease. In the MISS analysis, there were 2 prospective and 4 retrospective studies. Finally, the authors included 5 studies (with a total of 1364 patients) that directly compared durotomy rates during open-approach versus minimally invasive procedures. Studies of open-approach surgery for lumbar degenerative disease reported a total of 1031 durotomies across all procedures, for an overall durotomy rate of 8.11% (range 2%\u201320%). Prospectively designed studies reported a higher rate of durotomy than retrospective studies (9.57% vs 4.32%, p = 0.05). Selected MISS studies reported a total of 93 durotomies for a combined durotomy rate of 6.78%. In studies of matched cohorts comparing open-approach surgery with MISS, the durotomy rates were 7.20% (34 durotomies) and 7.02% (68), respectively, which were not significantly different.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Spinal surgery for lumbar degenerative disease carries a significant rate of unintended durotomy, regardless of the surgical approach selected by the surgeon. Interpretation of unintended durotomy rates for lumbar surgery is limited by a lack of prospective and cohort-matched controlled studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2015.7.focus15266","type":"journal-article","created":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T03:41:45Z","timestamp":1443670905000},"page":"E8","source":"Crossref","is-referenced-by-count":70,"title":["Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature"],"prefix":"10.3171","volume":"39","author":[{"given":"George M.","family":"Ghobrial","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital., Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thana","family":"Theofanis","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital., Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce V.","family":"Darden","sequence":"additional","affiliation":[{"name":"Orthocarolina Spine Center, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Kansas, Kansas City, Kansas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Harrop","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital., Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15266","series-title":"Spine J","first-page":"1828","article-title":"No difference in postoperative complications, pain, and functional outcomes up to 2 years after incidental durotomy in lumbar spinal fusion: a prospective, multi-institutional., propensity-matched analysis of 1,741 patients","volume":"14","author":"Adogwa","year":"2014"},{"key":"b2-focus15266","series-title":"Spine J","first-page":"1705","article-title":"Minimally invasive compared with open lumbar laminotomy: no functional benefits at 6 or 24 months after surgery","volume":"15","author":"Ang","year":"2015"},{"key":"b3-focus15266","series-title":"Spine J","first-page":"121","article-title":"Risk factors for unintended durotomy during spine surgery: a multivariate analysis","volume":"12","author":"Baker","year":"2012"},{"key":"b4-focus15266","series-title":"Asian Spine J","first-page":"639","article-title":"Incidental dural tears during lumbar spine surgery: a retrospective case study of 84 degenerative lumbar spine patients","volume":"8","author":"Blecher","year":"2014"},{"key":"b5-focus15266","series-title":"J Clin Neurosci","first-page":"544","article-title":"Durotomy is associated with pseudoarthrosis following lumbar fusion","volume":"22","author":"Bydon","year":"2015"},{"key":"b6-focus15266","series-title":"Spine (Phila Pa 1976)","first-page":"2663","article-title":"Incidental durotomy in spine surgery","volume":"25","author":"Cammisa","year":"2000"},{"key":"b7-focus15266","series-title":"Clin Neurol Neurosurg","first-page":"101","article-title":"Risk factors for incidental durotomy during lumbar surgery: a retrospective study by multivariate analysis","volume":"130","author":"Chen","year":"2015"},{"issue":"Suppl 1","key":"b8-focus15266","series-title":"Neurosurgery","first-page":"S57","article-title":"SPORT: Does incidental durotomy affect long-term outcomes in cases of spinal stenosis?","volume":"76","author":"Desai","year":"2015"},{"key":"b9-focus15266","series-title":"Neurosurgery","first-page":"833","article-title":"Spine patient outcomes research trial: do outcomes vary across centers for surgery for lumbar disc herniation?","volume":"71","author":"Desai","year":"2012"},{"key":"b10-focus15266","series-title":"Spine (Phila Pa 1976)","first-page":"678","article-title":"Variation in outcomes across centers after surgery for lumbar stenosis and degenerative spondylolisthesis in the spine patient outcomes research trial","volume":"38","author":"Desai","year":"2013"},{"issue":"15 Suppl","key":"b11-focus15266","series-title":"Spine (Phila Pa 1976)","first-page":"S26","article-title":"Minimally invasive lumbar fusion","volume":"28","author":"Foley","year":"2003"},{"key":"b12-focus15266","series-title":"J Spec Pediatr Nurs","first-page":"1","article-title":"Reporting guidelines: CONSORT, PRISMA, and SQUIRE","volume":"17","author":"Foster","year":"2012"},{"key":"b13-focus15266","series-title":"Injury","first-page":"397","article-title":"Incidental durotomy during spine surgery: incidence, management and complications. 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