Management of Dural Tears in Endoscopic Lumbar Spinal Surgery: A Review of the Literature

OBJECTIVE: The incidental dural tear is a common complication in lumbar spine surgery. It has been reported that the incidence of dural tears is much greater in endoscopic procedures. Primary closure via suturing remains challenging in endoscopic procedures. The objective of this study was to conduct a literature reviewon the surgical technique for dural closure and repair in endoscopic spine surgery. METHODS: A systematic literature search was performed using the database PubMed. In total, 12 studies reported specifically about the surgical treatment for dural tear in percutaneous and tubular assisted endoscopic technique. The dural tear rate, the technique of dural closure, postoperative time of bed rest, postoperative symptoms related to cerebrospinal fluid fistula, and revision surgery were assessed. RESULTS: The overall rate of dural tears in endoscopic spinal surgery was 2.7%, with a range from 0% to 8.6%. The incidence of a dural tear was much greater in cases with lumbar stenosis (3.7%) than in lumbar disc herniation (2.1%). The greatest rate was accompanied by resecting synovial cysts. In addition, the risk of dural tear is greater in bilateral decompression procedures via a unilateral approach. There is no consensus about the ideal technique for dural closure in endoscopic procedures. Furthermore, there is a debate whether dural tear requires surgical treatment or not. CONCLUSIONS: An autologous muscle or fat graft in combination with fibrin glue or a fibrin-sealed collagen sponge seems to be a good and safe method for the management of dural tear in lumbar endoscopic spine surgery.