Management of Incidental Durotomy: Results from a Nationwide Survey Conducted by the French Society of Spine Surgery.

Abstract Objective To obtain real-life data on the most common practices used for the management of incidental durotomy (ID) in France. Methods Data were collected from spinal surgeons using a practice-based online questionnaire (SurveyMonkey Inc.). The survey comprised 31 questions on the current management of ID in France. The primary outcome was the identification of areas of consensus and uncertainty on ID follow-up. Results A total of 217 surgeons (mainly orthopaedic and neurosurgeons) completed the questionnaire and were included in the analysis. There was a consensus on ID repair with 94.5% of the surgeons considering that an ID should always be repaired, if repairable, and 97.2% performing a repair if an ID occurred. The most popular techniques were a simple suture or locked continuous suture (48.3% versus 57.8% of surgeons, respectively). Non-repairable IDs were more likely to be treated with surgical sealants than with an endogenous graft (84.9% versus 75.5%, respectively). Almost two-thirds of surgeons (71.6%) who adapted their standard postoperative protocol after an ID recommended bed rest in the supine position. Among these, 48.8% recommended 24 h of bed rest while 53.5% recommended it for 48 h. The surgeons consider that the main risk factors for ID were revision surgery (98.6%), patient’s age (46.8%), surgeon’s exhaustion (46.3%) and patient’s weight (21.3%). Conclusions This nationwide survey reflects the lack of a standardized management protocol for ID. Habits among surgeons remain very heterogeneous. Further consensus studies are required in order to develop a standard management protocol for ID.