gms | German Medical Science

Objective: The intra- and postoperative management of incidental dura lesions in operations of the lumbar spine is not standardized. In the literature, various recommendations concerning the techniques of closing dural tears as well as immobilizing the patient postoperatively are given. It is the aim of our survey to obtain an overview on the current practice in Germany.

Method: The used questionnaire consisted of three questions and could be answered within a few minutes by checking boxes. Furthermore the respondent was allowed to add comments. The answers could be submitted online or by fax. In September 2012, the questionnaire was send to 149 German neurosurgical departments. Neurosurgeons working in private practice were not contacted. In the following weeks we received 109 replies (73.2%).

Results: 78 hospitals (71.6%) answered to treat dural tears by direct suture (without / with muscle patch) in combination with fibrin-coated fleece or fibrin glue. In 20 hospitals (18.3%) dural tears are treated with suture alone, in 7 (6.4%) with fibrin-coated fleeces alone and in 2 (1.8%) with fibrin glue alone. 67 neurosurgical clinics (61.5%) stated to decide on postoperative bed rest depending on the quality of intraoperative dura closure. In 42 (38.5%) neurosurgical clinics the postoperative management is not guided by the quality of intraoperative dura closure. In 27 neurosurgical clinics (24.8%) patients with dural tear are mobilized without restriction. In 79 hospitals (72.5%) the patients are kept in bed one to three days, in 2 hospitals (1.8%) more than three days.

Conclusions: There is no standardized procedure for the treatment of incidental durotomies in lumbar spine surgery. Bed rest is frequently used. As bed rest prolongs the hospital stay with associated costs and the potential of a higher rate of thromboembolic complications, this issue should be addressed by conducting a prospective multicenter trial.