Incidence of Dural Tears in Open versus Minimally Invasive Spine Surgery: A Single-Center Prospective Study

STUDY DESIGN: A prospective comparative study. PURPOSE: To compare the incidence of unintended durotomy and return to work after open surgery versus minimally invasive spine surgery (MIS) for degenerative lumbar pathologies. OVERVIEW OF LITERATURE: The incidence of accidental durotomy varies between 0.3% and 35%. Most of these are from open surgeries, and only a handful of studies have involved the MIS approach. No single-center studies have compared open surgery with MIS, especially in the context of early return to work and dural tear (DT). METHODS: This study included 420 operated cases of degenerative lumbar pathology with a prospective follow-up of at least 6 months. Patients were divided into the open surgery and MIS groups, and the incidences of DT, early return to work, and various demographic and operative factors were compared. RESULTS: A total of 156 and 264 patients underwent MIS and open surgery, respectively. Incidental durotomy was documented in 52 cases (12.4%); this was significantly less in the MIS group versus the open surgery group (6.4% vs. 15.9%, p<0.05). In the open surgery group, four patients underwent revision for persistent dural leak or pseudomeningocele, but none of the cases in the MIS group had revision surgery due to DT-related complications. The incidence of DT was higher among patients with high body mass index, patients with diabetes mellitus, and patients who underwent revision surgery (p<0.05) regardless of the approach. The MIS group returned to work significantly earlier. CONCLUSIONS: MIS was associated with a significantly lower incidence of DT and earlier return to work compared with open surgery among patients with degenerative lumbar pathology.