Dura mater is one of three protective membrane layers that line the skull and vertebral canal. The purpose of this watertight sac is to provide protection for spinal nerves and the spinal cord itself. If a tear occurs, it can cause clear, colorless cerebrospinal fluid to leak, which may result in an infection and other health issues. Here’s what you need to know about dural tears that might result from spine surgery and what can be done to minimize the risk of experiencing a tear.
What Causes Dural Tears During Spine Surgery?
Tears sometimes result from sudden trauma to the spine that has nothing to do with surgery. However, most instances of dural tears happen during spine surgery. Tears are more likely to occur when patients need another spine operation. It’s believed this is because such procedures often involve removing excess scar tissue, and the process of moving this tissue may cause a tear.
While doctors normally take precautions to prevent unintentional damage to nerves, soft tissue, and sensitive dura mater, there are times when the manipulations and movements taking place during surgery may cause a tear. Most of the time, Beverly Hills spine surgeons can detect and correct a dural tear. However, if a tear in the dura mater goes undetected, it may contribute to issues such as:
- A cerebrospinal fluid leak
- Severe headaches that usually get better when lying down and worse when standing up
- Nausea and vomiting
- Increased light sensitivity
- Spinal meningitis and other infections
How Can Dural Tears Be Prevented?
It’s not always entirely possible to prevent an accidental dural tear. In some cases, the dura mater has to be purposely torn to administer a spinal tap or access the affected part of the spine. If this is the case, the tear will be repaired after the necessary work is completed. Repair usually involves an epidural blood patch or sutures.
One possible way to reduce your risk of having a tear is to see if you are a candidate for a minimally invasive procedure. Surgery of this nature is done with smaller incisions and special instruments and techniques, which means there’s less risk of trauma to nearby structures and sensitive membranes like dura mater. Diagnosis and treatment of dural tears resulting from spine surgery typically involves:
- An MRI or CT scan to confirm a suspected leak if a patient is having unexplained discomfort and other symptoms suggesting a dural tear
- Hydration by IV to help with symptoms
- A second surgery to repair the tear
- Insertion of a small drain above the tear to lower spinal fluid pressure
- Bed rest for 24 hours after a second surgery is done to minimize cerebrospinal fluid movement so the seal becomes watertight again*
Bed rest may also be recommended prior to considering a second surgery to see if the tear will heal on its own.
Occurring during 3 to 15 percent of all spine-related procedures, according to one estimate, dural tears during spine surgery aren’t a common occurrence. In one study, more than 1,300 patients who had spine surgery between 2000 and 2010 were evaluated. Only 23 of them had dural tear complications. In each of those instances, the tears were small and repairable. There were no further complications, and none of the patients with dural tears required a second surgery.
If you are experiencing chronic pain in the back or neck and think you might need surgery, reach out to The Spine Institute today. We specialize in procedures such as traditional fusion surgery and spinal cord stimulation. Beverly Hills patients can call 310-828-7757 to schedule an in-person evaluation.