AIM OF THE STUDY: To study the incidence of dural tears, to understand and evaluate causes for dural tears, pattern and extent of dural tears and methods to repair and final outcome in such patients following dural tear.
MATERIALS AND METHODS: We evaluated all the patients who underwent lumbar spine surgery from Jan 2004 to December 2008 in our institute for the incidence of dural tears. All the surgeries were done by a single surgeon. Indications for surgery, site and extent of dural tear, associated fresh neurological injury and methods to close the tear was noted in the operative notes. Post operative mobilization protocol, fate of repair in the post operative period, need to repeat surgery were noted. Also an assessment of final outcome at 2 year were made regarding VAS and oswestry disability index and these were compared to non dural tear group.
RESULTS: During the study period there were 96 surgeries, with 13 dural tears (13.54%), 12 of them were in lumbar canal stenosis group undergoing multiple level decompressions with statistically significant higher age groups. Depending upon the tear patterns, we have classified these tears into three groups: central, peripheral, and posterior. Peripheral tears are large tears and were closed with a fascial graft. Long term clinical outcome were more or less same in both dural tear and non dural tear groups (improvement of oswestry disability index showed a mean score of 21.66 in non dural tear group, 22.81 in dural tear group) with no statistical significant difference.
CONCLUSIONS: Dural tears are common in gross lumbar canal stenosis surgery especially involving multiple level decompressions. We have classified these tears into three groups which helps to device a treatment plan for the tear. When dural tears are closed properly, long term clinical outcome does not differ from those without dural tears.