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Preferences of Spine Surgeons With Regard to Management of Intraoperative Durotomy

A Survey of Current Management

Pendi, Arif, MS*; Wang, Jeffrey C., MD; Bederman, Stacey Samuel, MD, PhD, FRCSC; Farhan, Saifal-Deen, MD§; Bhatia, Nitin N., MD§; Lee, Yu-Po, MD§; Ashraf, Jahanzeb, MS; Acosta, Frank L., MD

doi: 10.1097/BSD.0000000000000673

Study Design: This was a cross-sectional study.

Objective: The objective of this study was to determine spine surgeons’ preferences for the intraoperative and postoperative management of intraoperative durotomy (IDT) in decompression and spinal fusion surgeries.

Summary of Background Data: Management guidelines for IDT remain elusive. Traditionally, management consists of intraoperative suturing and postoperative bed rest. However, preferences of North American spine surgeons may vary, particularly according to type of surgery.

Materials and Methods: Spine surgeons of AO Spine North America (AOSNA) were surveyed online anonymously to determine which techniques they preferred to manage IDT in decompression and fusion. Differences in preferences according to surgery type were compared using the Fisher exact test. A series of linear regressions were conducted to identify demographic predictors of spine surgeons’ preferences.

Results: Of 217 respondents, most were male (95%), orthopedic surgeons (70%), practiced at an academic center (50%), were in practice 0–19 years (71%) and operated on 100–300 patients per year (70%). The majority of surgeons applied sutures (93%–96%) and sealant (82%–84%). Surgeons also used grafts (26%–27%), drains (18%), other techniques (4%–5%), blood patch (2%–3%), or no intraoperative management (1%–2%). Postoperatively, most surgeons recommended bed rest (74%–75%). Antibiotics (22%), immediate mobilization (18%–20%), reoperation (14%–16%), other techniques (6%), or no postoperative management (5%) were also preferred. Management preferences did not vary significantly between decompression and fusion surgeries (all P-values>0.05). Specialty, practice facility, years in practice, and patients per year were identified as independent predictors of IDT management preferences (P<0.05).

Conclusions: Although North American spine surgeons preferred to manage IDT with sutures augmented by sealant followed by bed rest after surgery, less common techniques were also preferred during the intraoperative and postoperative periods. Notably, intraoperative and postoperative IDT management preferences did not change in accordance to the type of surgery being conducted.

Level of Evidence Level V.

*School of Medicine, Wayne State University, Detroit, MI

Department of Orthopaedic Surgery, University of Southern California, Los Angeles

Restore Orthopaedics and Spine Center, St. Joseph Hospital

§Department of Orthopaedic Surgery, University of California Irvine, Orange, CA

School of Medicine, American University of the Caribbean, Cupecoy, St Martin

Department of Neurological Surgery, University of Southern California, Los Angeles, CA

The authors declare no conflict of interest.

Reprints: Arif Pendi, MS, Department of Orthopaedic Surgery, University of California Irvine Medical Center, 101 The City Drive S, Pavilion 3, Orange, CA 92868 (e-mail:

Received November 22, 2017

Accepted May 22, 2018

© 2018 by Lippincott Williams & Wilkins, Inc.