Management of dural tears in spinal surgery

Dural tears are one of the most common complications of spinal surgery. Deleterious consequences of dural leaks include dural-cutaneous fistulas that can lead to meningitis, arachnoiditis or epidural abscess, impaired wound healing, wound infection, pseudomeningocele formation, nerve root entrapment, and headache. Primary watertight closure is the most important aspect of treatment. If a dural tear is encountered during spine surgery, a direct suture repair is recommended. If the repair is tenuous or if suture repair is not possible due to location or tissue quality, use of adjuncts should be considered.