Minimally invasive spine surgery associated with significantly lower incidence of dural tear in those with degenerative lumbar pathologies

Ayush Sharma

Minimally invasive spine surgery results in a significantly lower incidence of dural tear and complications when compared to open surgery in patients with degenerative lumbar pathologies, new research suggests.

The study—the findings of which were presented by Ayush Sharma (Dr. B.A.M. Hospital, Mumbai, India) at the the Global Spine Congress annual meeting (3–6 November 2021, Paris, France)—included 420 operated cases of degenerative lumbar pathology with prospective follow-up of at least six months. Cases were divided into open and minimally invasive surgery (MIS) groups.

There were 156 patients who underwent MIS surgery compared with 264 who underwent open surgery. The majority of the study participants fell within the age group of 41-60 years (48% among MIS patients and 64.4% among open cases). Incidental durotomy was documented in 52 (12%) cases.

On comparing the two groups, incidence of dural tear was significantly lower in the MIS group (6.4%) compared to the open group (15.7 %; p<0.05). On further analysis, depending on type of surgery, while the incidence of dural tear was comparable between the two groups for decompression and fusion surgeries, the MIS group had less incidence of dural tear for discectomy and in revision surgeries. In the open group, four patients underwent revision for persistent dural leak or pseudo-meningocele but none of the cases in the MIS group had revision surgery due to complications related to dural tear.

The distribution of age, gender and risk factors was comparable between the two groups. Incidence of dural tear was significantly high for patients with a high Body Mass Index (BMI) and diabetes mellitus as well as those undergoing revision surgery (p<0.05) irrespective of the approach to surgery.

Speaking to Spinal News International, Sharma said: “The MIS approach during discectomy mainly involved flavectomy or a small laminotomy where a small amount of ligamentum flavum or lamina is removed to approach the disc. In open approach, the amount of laminectomy or flavectomy is comparatively higher.

“This may explain why the MIS approach had lesser risk of dural tear in cases of discectomy. For revision surgery also, the tubular approach allows the surgeon to skip the midline scar tissue and fibrosis resulting in a lesser chance of incidental dural tear.”

The research has been accepted for publication in Asian Spine Journal and will be available soon.


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