gms | German Medical Science

Objective: This study was intended to assess the frequency, management and risk factors of inadvertent dural tears in minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Method: This retrospective monocentric study implies 372 patients who underwent MIS TLIF in 514 levels between 2006 and 2014. The frequency of inadvertent dural tears, intraoperative closure technique, body mass index of patients and history of previous surgery were recorded. No subfascial drain was used. Patients were usually mobilized within 24 hours after surgery.

Results: We identified 32 inadvertent dural tears in 514 MIS TLIF levels (6.2 %). Analysis showed a statistically significant relation of inadvertent dural tears to overweight patients with a body mass index <FONT face=symbol>³</FONT>25 kg/m² (P < 0.05). Patient age older than 65 years tended to be a positive predictor for inadvertent dural tears but did not reach statistical significance (P = 0.0657). History of previous surgery at the same level was found not to be a predictor of inadvertent dural tears (P = 0.1535). We observed no dural-tear-associated complications like a CSF fistula or need for placing a lumbar drain.

Conclusions: The frequency of inadvertent dural tears in MIS TLIF is low. Overweight is a risk factor for inadvertent dural tears. Patients with inadvertent dural tears in MIS TLIF can usually be mobilized within 24 hours of surgery without increased risk for complications as the minimally invasive approach seems to minimize dural-tear-associated complications.