Durotomy Incidence in Degenerative Lumbar Spine Surgeries: A Systematic Review and Comparative Meta-Analysis of Proportions
In brief
Incidental tears occur in 5% of lumbar surgery, more often in revisions
Across 39 studies and 283,650 patients, about 5% of degenerative lumbar operations involved an incidental tear of the spinal covering; rates were 8.7% in revision surgery and 4.5% in first-time surgery. Rates were similar for open and minimally invasive approaches, but estimates varied widely, and about 1 in 10 tears led to persistent cerebrospinal fluid leakage.
- Journal
- Neurosurgery (Q1)
- Published
- 8 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Teleale F Gebeyehu, Lucas G Garmo, Bhaskar Kannan, Meredith R Schorsch, Shaan Patel, Joshua E Heller, et al.
- PMID
- 42847718
- DOI
- 10.1227/neu.0000000000004255
Why clinicians should know about it
- Picked for Spine Surgery (paper of the day, 11 October 2026): Incidence of durotomy in lumbar degenerative surgery
Abstract
BACKGROUND AND OBJECTIVES: Spinal durotomy (SD) is a well-recognized occurrence and potential adverse event of lumbar spine surgery for degenerative conditions. Incidences have been reported between 8.11% in primary open surgery and 6.78% in minimally invasive surgery (MIS). However, given increasing surgical volume, surgical complexity, and evolving techniques, an updated synthesis of contemporary incidence is needed. The purpose here is to determine the overall incidence of SD in lumbar spine surgery for degenerative pathology and various subgroups of surgeries. METHODS: A systematic review and a concurrent meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed was searched using predefined Medical Subject Headlines terms and keywords for studies published between May 15, 2015, and February 3, 2026. Studies involving adult patients undergoing lumbar surgery for degenerative conditions and reporting both total cases and SD events were included. Data extraction and risk of bias assessment were independently performed by multiple reviewers using the Newcastle-Ottawa Scale and Cochrane tools. Pooled incidence estimates were calculated using weighted proportions. Heterogeneity was assessed using Higgins' I2, and publication bias was evaluated using funnel plots and Egger's regression. RESULTS: Thirty-nine studies comprising 283 650 patients were included. A total of 6476 incidental durotomies were identified. The pooled incidence of SD (95% CI) was 5% (3.5-7.0), with significant heterogeneity (I2 = 99.4%). Subgroup analysis demonstrated SD rates of 4.5% (2.7-7.5) in primary surgeries, 8.7% (4-17.9) in revision cases, 6.8% (5.2-8.9) in open surgery, and 6.4% (3.8-10.6) in MIS/endoscopic approaches. Persistent cerebrospinal fluid leak occurred in 10.7% (6.2-17.7) of SD cases. CONCLUSION: The contemporary incidence of incidental durotomy in lumbar degenerative surgery is approximately 5%, comparable with, yet lower than previously reported estimates. Revision surgery remains associated with a higher risk. No meaningful difference was observed between open and MIS/endoscopic approaches.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.