Minimally invasive spine surgery reduces incidence of dural rupture

New research shows that minimally invasive spine surgery results in a significantly lower incidence of dural rupture and complications compared to open surgery in patients with degenerative lumbar pathologies.

The study, whose findings were presented by Ayush Sharma (Dr. BAM Hospital, Mumbai, India) at the Global Spine Congress annual meeting (3-6 November 2021, Paris, France), included 420 degenerative lumbar pathology cases operated on. with at least six months of prospective follow-up. The cases were divided into open and minimally invasive surgery (MIS) groups.

There were 156 patients who underwent MIS surgery, compared with 264 who underwent open surgery. The majority of the study participants were between the ages of 41-60 (48% in MIS patients and 64.4% in open cases). Incidental durotomy was documented in 52 (12%) cases.

When the two groups were compared, the incidence of dural tear in the MIS group (6.4%) was significantly lower than in the open group (15.7%; p<0.05). In further analysis, the incidence of dural tears was comparable between the two groups for decompression and fusion surgeries, depending on the type of surgery, while the MIS group had a lower incidence of dural tears for discectomy and revision surgeries. Permanent dural leak or pseudo-meningocele revision was performed in four patients in the open group, but revision surgery was not performed in any of the patients in the MIS group due to complications due to dural rupture.

Age, gender, and distribution of risk factors were comparable between the two groups. The incidence of dural tears was significantly higher in patients with a high Body Mass Index (BMI) and diabetes mellitus, and in those who had revision surgery, regardless of the surgical approach (p<0.05).

Speaking to Spinal News International, Sharma said: "During discectomy, the MIS approach mainly involved flavectomy, or a small laminotomy in which a small amount of ligamentum flavum or lamina is removed to approach the disc. The amount of laminectomy or flavectomy in the open approach is relatively large.

“This may explain why the MIS approach has a lower risk of dural rupture in discectomy cases. For revision surgery, too, the tubular approach allows the surgeon to bypass midline scar tissue and fibrosis, resulting in a reduced chance of incidental dural rupture.”