Abstract
Purpose Incidental durotomy is an intraoperative complication that occurs in 3 to 27% of
lumbar spine surgeries. It has been reported more commonly following revision spinal
procedures.
Study Objectives To investigate the frequency of incidental durotomy while performing transforaminal
lumbar interbody fusion (TLIF) using the modified Wiltse approach. A secondary goal
was to compare the incidence of durotomy in patients undergoing primary spine surgery
with those undergoing revision surgery.
Methods A group of consecutive patients who had undergone (TLIF) in the last 10 years ending
in 2015 were enrolled in the study. All patients underwent TLIF via the modified Wiltse
approach that included a central midline skin incision, followed by a paravertebral
blunt dissection of the paraspinal muscles to reach the transverse processes. The
deep paravertebral dissection was done conservatively, one side at a time. Demographic
and clinical data were collected when relevant to the comparison.
Results The study cohort encompassed 257 patients: 200 primary cases and 57 revisions. The
frequency of incidental durotomy was equal in both groups: 3.5% each (7/200 and 2/57).
All durotomies were repaired primarily. No other immediate or late complications were
observed during follow-up.
Conclusion The present study displays a limited incidence of durotomy in the primary interventions
and to a lesser degree in the revisions, all of which had used a TLIF performed with
the modified Wiltse approach. This procedure probably circumvented the need for further
revisions.
Keywords
spinal surgery - transforaminal lumbar interbody fusion - revision - incidental durotomy
