This 2010 narrative review from JAAOS synthesizes the incidence, risk factors, repair strategies, and outcomes of dural tears in spine surgery, covering anatomy, CSF physiology, primary and sutureless repair techniques, subarachnoid drainage, and postoperative management across cervical and lumbar procedures.
When you encounter a dural tear intraoperatively, your default is primary watertight suture repair tested with a Valsalva — but if the dura is calcified, friable, or exposure is limited (especially in MIS or anterior cervical cases), sutureless collagen matrix onlay is a validated fallback.
Postoperatively, position the patient to minimize hydrostatic pressure at the repair site: flat for lumbar tears, upright for cervical tears.
This 2010 narrative review from JAAOS synthesizes the incidence, risk factors, repair strategies, and outcomes of dural tears in spine surgery, covering anatomy, CSF physiology, primary and sutureless repair techniques, subarachnoid drainage, and postoperative management across cervical and lumbar procedures.
When you encounter a dural tear intraoperatively, your default is primary watertight suture repair tested with a Valsalva — but if the dura is calcified, friable, or exposure is limited (especially in MIS or anterior cervical cases), sutureless collagen matrix onlay is a validated fallback.
Postoperatively, position the patient to minimize hydrostatic pressure at the repair site: flat for lumbar tears, upright for cervical tears.