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James L. West, Madison Arnel, Atilio E. Palma, John Frino, Alexander K. Powers, and Daniel E. Couture

high rates of incidental durotomy following revision surgery, likely secondary to scar tissue formation and poor dissection planes. 2 , 4 , 13 Although there is a wide body of literature examining incidental durotomies in the adult spinal surgery population, little has been published regarding these occurrences in the pediatric population. Specifically, few studies have sought to examine the overall incidence of durotomy in the pediatric population and what factors, if any, seem to influence this. 4 , 7 This is a rather important research question because the

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Jeff Ehresman, Zach Pennington, Aditya V. Karhade, Sakibul Huq, Ravi Medikonda, Andrew Schilling, James Feghali, Andrew Hersh, A. Karim Ahmed, Ethan Cottrill, Daniel Lubelski, Erick M. Westbroek, Joseph H. Schwab, and Daniel M. Sciubba

I ncidental durotomy—defined by compromise of the thecal sac with or without CSF leakage—is a relatively common complication of lumbar spine surgery. Previous reports have documented incidental durotomy to occur at rates varying from 0.3% for lumbar discectomy 1 to 11% for operations to correct adult spinal deformity. 2 Consequences of dural tears include postoperative headache, meningitis, new-onset neurological deficit, pseudomeningocele, need for surgical revision, and significant financial costs to the patient and health system. 3–6 Previous

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Ketan Verma, Anne H. Freelin, Kelsey A. Atkinson, Robert S. Graham, and William C. Broaddus

incidental durotomy is an uncommon practice. 13 , 16 Only a few small studies have compared immediate mobilization with prolonged bed rest after a primarily closed incidental durotomy. 17–21 Some spine surgeons at our institution do not prescribe any activity restriction after an incidental durotomy, while others keep patients flat overnight, and some prescribe flat bed rest for > 24 hours. This practice is not based on the size or location of the durotomy, age of the patient, or other patient comorbidities. Since the postoperative protocols did not differ otherwise

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Paul McMahon, Marina Dididze, and Allan D. Levi

in the literature, our a priori hypothesis in the present study was a “prospective determination of incidence.” Incidental durotomy is commonly listed on consent forms as a potential complication; however, the actual impact on patient outcomes is unclear. Few studies have examined patient outcomes following an ID. There is wide variation in outcomes following IDs, ranging from no increased morbidity 6 , 7 , 17 , 41 and simply an increase in operative time, blood loss, and duration of stay to a strong tendency for worsening outcomes including a tendency toward

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Yoshimasa Takahashi, Tetsuro Sato, Hironori Hyodo, Tomomaro Kawamata, Eiji Takahashi, Naohisa Miyatake, and Masako Tokunaga

incidental durotomy were also reviewed. Immediately after the operation, the primary surgeon created an intraoperative record that included a figure. In our department, since 2002, it has been mandatory to draw a figure of the decompressed area, causative factors of compression (for example, articular processes, bony spurs, thickness of the ligamentum flavum, herniated discs, and cystic lesions), and any specific matters (for example, unintended dural tear or accidental damage to a nerve). The anatomical position of the incidental durotomy was reviewed using these

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Atman Desai, Perry A. Ball, Kimon Bekelis, Jon D. Lurie, Sohail K. Mirza, Tor D. Tosteson, and James N. Weinstein

durotomy on long-term outcomes remains controversial. 12 , 21 The Spine Patient Outcomes Research Trial (SPORT), 28 , 29 a multicenter trial including both randomized and observational cohorts initiated in March 2000, provides a valuable opportunity to examine long-term outcomes after incidental durotomy during discectomy, given its large cohort size, 28 , 29 standardized outcome measures, and long-term follow-up. Furthermore, all discectomies were performed using the same approach (open), and all were performed in patients without a history of lumbar spine surgery

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Garrett Q. Barr and Peter L. Mayer

Spinal subdural hygroma (SSH) was first described by Schiller et al. 73 years ago. 1 Various case reports and small series of spinal subdural hematomas associated with trauma, anticoagulation therapy, blood disorders, spinal puncture, and vascular malformation/neoplasm have been reported. 2–7 In addition, SSH may develop as a complication of spinal surgery. 8–15 In most postoperative cases reported previously, incidental durotomy was noted at the time of surgery. 9–12 We present a series of five cases of acute/subacute SSH without incidental durotomy. To

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Aristedis Rovlias, Emmanuel Pavlakis, and Serafim Kotsou

root herniation and laceration, among others. This postoperative neurological deficit could also be associated with tension pneumorachis in addition to other more common causes. We describe the first case of symptomatic pneumorachis associated with accidental awakening of the patient during the repair process of an incidental durotomy leading to incomplete cauda equina syndrome. Case Report Examination. This 64-year-old woman had a 2-year history of persistent low-back pain with left L-5 radiculopathy symptoms due to a left posterolateral L4

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Dmitry Ruban and John E. O'Toole

importance of lumbar spine region as a risk factor is unclear, as we had significantly more lumbar than cervical or thoracic cases, which could bias the results. Primary repair of incidental durotomy is considered to have the highest rate of success, 3 , 11 , 15 , 19 , 36 although this is not always technically feasible due to thin dura or inaccessible location of the durotomy. This is particularly true in minimally invasive cases, in which a small tubular retractor may not allow the necessary manipulation of instruments to attain primary closure of the dura. In our

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Frank Mihlon, Peter G. Kranz, Andreia Roxana Gafton, and Linda Gray

effective, the drawbacks include the generic risks and morbidities associated with reoperating on a recently postoperative spine. CT-guided percutaneous epidural patching targeted to the dural defect offers an alternative to surgery 3 , 4 and can be performed without general anesthesia and with minimal risk and discomfort to the patient. This article is a case series reporting the Duke neuroradiology experience using targeted CT-guided percutaneous epidural patching to repair incidental durotomies incurred during spinal surgery. Methods This investigation is a