Efficacy of conservative and surgical strategies in managing incidental durotomy following lumbar microdiscectomy

Background: Incidental durotomy is a well-recognized complication of lumbar microdiscectomy that, if not appropriately managed, may result in cerebrospinal fluid (CSF) leakage, prolonged hospitalization, and neurological morbidity. This study aimed to evaluate the effectiveness of intraoperative multimodal repair techniques and structured conservative postoperative strategies in managing incidental durotomy. Methods: A retrospective cohort study was conducted on 400 patients who underwent lumbar microdiscectomy at King Hussein Medical Center between January 2022 and December 2023. Patient demographics, the incidence of incidental durotomy, intraoperative repair techniques, postoperative management protocols, and clinical outcomes were assessed. Results: The overall incidence of incidental durotomy was 8.25%, rising to 16% among patients with recurrent disc herniation. Immediate intraoperative identification and layered repair—including dural suturing, fibrin sealants, and fat grafting—enabled successful conservative management in 93.9% of cases. Only two patients required surgical re-intervention due to persistent CSF leakage. At both 1-month and 6-month follow-ups, no patients exhibited persistent CSF leaks, wound infections, pseudomeningocele, or new neurological deficits. Conclusion: Prompt intraoperative recognition of incidental durotomy, followed by meticulous multimodal repair and structured conservative management, effectively minimizes complications. Vigilant postoperative monitoring and timely surgical re-intervention remain critical for ensuring optimal outcomes, particularly in high-risk revision cases.