Accidental Dural Tears in Minimally Invasive Spinal Surgery for Degenerative Lumbar Spine Disease

Stefan Aspalter, Wolfgang Senker, Christine Radl, Wolfgang Aichholzer, Kathrin Aufschnaiter-Hießböck, Clemens Leitner, Nico Stroh, Wolfgang Trutschnig, Andreas Gruber, Harald Stefanits

Research output: Contribution to journalArticlepeer-review


Background: One of the most frequent complications of spinal surgery is accidental dural tears (ADTs). Minimal access surgical techniques (MAST) have been described as a promising approach to minimizing such complications. ADTs have been studied extensively in connection with open spinal surgery, but there is less literature on minimally invasive spinal surgery (MISS). Materials and Methods: We reviewed 187 patients who had undergone degenerative lumbar spinal surgery using minimally invasive spinal fusions techniques. We analyzed the influence of age, Body Mass Index (BMI), smoking, diabetes, and previous surgery on the rate of ADTs in MISS. Results: Twenty-two patients (11.764%) suffered from an ADT. We recommended bed rest for two and a half to 5 days, depending on the type of repair required and the amount of cerebrospinal fluid (CSF) leakage. We could not find any statistically significant correlation between ADTs and age (p = 0.34,), BMI (p = 0.92), smoking (p = 0.46), and diabetes (p = 0.71). ADTs were significantly more frequent in cases of previous surgery (p < 0.001). None of the patients developed a transcutaneous CSF leak or post-operative infection. Conclusions: The frequency of ADTs in MISS appears comparable to that encountered when using open surgical techniques. Additionally, MAST produces less dead space along the corridor to the spine. Such reduced dead space may not be enough for pseudomeningocele to occur, cerebrospinal fluid to accumulate, and fistula to form. MAST, therefore, provides a certain amount of protection.

Original languageEnglish
Article number708243
JournalFrontiers in Surgery
Publication statusPublished - 20 Jul 2021

Bibliographical note

Funding Information: Funding. Publishing was supported by the Johannes Kepler Open Access Publishing Fund.

Copyright © 2021 Aspalter, Senker, Radl, Aichholzer, Aufschnaiter-Hießböck, Leitner, Stroh, Trutschnig, Gruber and Stefanits.

Fields of Science and Technology Classification 2012

  • 302 Clinical Medicine
  • 101 Mathematics


  • cerebrospinal fluid leak
  • dural tear
  • minimally invasive surgical procedure
  • spinal fusion
  • spine
  • spine surgery

Cite this