Dural Leak: Is it Deterrent to Outcomes in Spine Surgery? 10 Years Retrospective Analysis of Incidence, Management Protocol and Surgical Outcomes.

STUDY DESIGN Retrospective case-control study. OBJECTIVES To review the incidence of dural leaks, evaluate the efficacy of primary closure of durotomy and to study its effect on clinical outcome. The secondary aim is to classify the dural leaks and proposing a treatment algorithm for dural leaks. SUMMARY OF BACKGROUND DATA Dural leaks are described as one of the fearful complications in spine surgery. Literature evaluating the actual incidence, ideal treatment protocol, efficacy of primary repair techniques and its effects on long-term surgical outcomes are scanty. METHODS It was a retrospective analysis of 5390 consecutively operated spine cases over a period of ten years. All cases were divided into two groups-study group (with dural leak-255) and control group (without dural leak-5135). Dural leaks were managed with the proposed treatment algorithm. Blood loss, surgical time, hospital stay, time for return to mobilization, pain free status and clinical outcome score (ODI, VAS, NDI and Wang criteria) were assessed in both groups at regular intervals. The statistical comparison between two groups was established with chi-square and t-tests. RESULTS The overall incidence of dural leaks was 4.73% with highest incidence in revision cases (27.61%). There was significant difference noted in mean surgical blood loss (P 0.001), mean hospital stay (P 0.001), time to achieve pain free status after surgery and return to mobilization between two groups. However, no significant difference was noted in operative time (P 0.372) and clinical outcome scores at final follow up between the two groups. CONCLUSION Primary closure should be undertaken in all amenable major dural leak cases. Dural leaks managed as proposed by the author's treatment algorithm has shown a comparable clinical outcome as in patients without dural leaks. Dural leak is friendly adverse event that do not prove a deterrent to long-term clinical outcome in spine surgeries. LEVEL OF EVIDENCE 4.