Incidence and management of incidental durotomy using closed wound drainage after posterior cervical decompression for degenerative cervical myelopathy: a retrospective analysis of 531 cases.

Authors

Ayush Sharma, Shubham Kadam, Ena Pradhan, Nandan Marathe, Ajit Rampure

Published in

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. Jul 24, 2026. Epub Jul 24, 2026.

Abstract

Incidental durotomy (ID) is well-recognized complication of spine surgery. This study aimed to determine the incidence of incidental durotomy during posterior cervical decompression for degenerative cervical myelopathy and to evaluate clinical outcomes following a standardized management protocol using closed wound drainage.
A retrospective review was performed of 531 consecutive patients who underwent posterior cervical laminectomy for degenerative cervical myelopathy over an 8-year period. Incidental durotomies were classified as intraoperatively recognized or postoperatively identified. Recognized dural tears were repaired primarily with 6 - 0 Prolene whenever feasible and reinforced with fibrin sealant. Irreparable tears were managed using collagen matrix onlay. All wounds, including those without ID were closed in a watertight multilayer fashion with placement of a subfascial closed wound drain positioned away from the dural repair site. In patients with recognized or suspected incidental durotomy, the drain reservoir was not activated, allowing passive closed drainage without negative suction. The primary outcome was the incidence of incidental durotomy. Secondary outcomes included repair method, hospital stay, postoperative complications, and need for revision surgery.
Incidental durotomy occurred in 42 of 531 patients, giving an incidence of 7.9%. Thirty tears were recognized intraoperatively, while 12 were identified postoperatively based on clear CSF collection in the drain and clinical features of CSF leakage. Primary repair was possible in 9 cases, while 21 irreparable tears were managed with collagen matrix onlay. Patients with incidental durotomy had a significantly longer hospital stay than those without durotomy. One patient developed postoperative bifrontal pneumocephalus, which resolved with conservative treatment. No patient required revision surgery for CSF leak-related complications.
In this retrospective series of 531 patients undergoing posterior cervical decompression for degenerative cervical myelopathy, incidental durotomy occurred in 7.9% of cases. A standardized protocol consisting of watertight multilayer closure, distant anti-gravity drain placement, passive closed drainage in patients with CSF leak, and delayed drain removal was associated with favorable clinical outcomes. No patient required reoperation for CSF leak-related complications. These findings suggest that the protocol may be a safe and practical strategy for managing recognized and missed incidental durotomy.

PMID:
42496726
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.

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