O1049: Dural Tears in Pediatric Posterior Spinal Fusions

Background: There is little published information on dural tears in pediatric spine surgery. Our purpose was to report on the frequency and risk factors of incidental dural tears, as well as the types and effectiveness of treatment.

Methods: A retrospective review of all pediatric patients who underwent a posterior spinal fusion (PSF) between 2004-2019 at a tertiary children’s hospital was conducted. Electronic medical records were reviewed for presence of an incidental dural tear, previous PSF, repair method, and patient outcomes.

Results: 3,045 PSFs were reviewed, with 104 dural tears identified in 99 patients (3.4% overall incidence). Mean follow-up was 32.3 months (range: 0.1-142.5 months). When the cause of the dural tear was specified, 84% (78/93) occurred during exposure, 5% (5/93) during pedicle screw placement, 4% (4/93) during osteotomy, 2% (2/93) during removal of implants, and 2% (2/93) during intra-thecal injection of morphine. The rate of dural tears during primary PSF was significantly lower than during revision PSF procedures (primary: 2.8%; 68/2,463 versus revision: 6.2%; 36/582; p < 0.001). 85.6% (89/104) of dural tears were repaired and/or sealed intra-operatively, while in 14.4% (15/104) of cases, there was spontaneous resolution of the CSF leak by the end of the procedure and no repair was attempted.

13.5% (14/104) of patients developed post-operative headaches, which resolved at a mean of 7.6 days (range: 2-17 days). Patients that were placed on bedrest immediately after surgery (12.5%; 5/40) had similar rates of post-operative headaches as patients that had not been placed on bedrest (14.1%; 9/64) (p > 0.99). Four patients that underwent intra-operative repair had secondary procedures to address persistent CSF leaks. Two patients were treated with placement of drains, 1 patient had revision dural repair, and one patient had surgical exploration with no CSF leak identified and no further leakage. The 15 patients with spontaneous resolution had a similar rate of postoperative headaches (13.3%; 2/15) as those who had a dural repair (13.5%; 12/89) (p > 0.999), and none of them (0/15) required any further intervention.

Conclusion: Incidental dural tears occurred in 3% of posterior spinal fusions in this series, and intra-operative repair was clinically successful in 96% (85/89) of patients. Post-operative bed rest did not affect post-operative headaches.