Durotomy Incidence in Degenerative Lumbar Spine Surgeries: A Systematic Review and Comparative Meta-Analysis of Proportions.
Publication/Presentation Date
10-8-2026
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.
ISSN
1524-4040
Published In/Presented At
Gebeyehu, T. F., Garmo, L. G., Kannan, B., Schorsch, M. R., Patel, S., Heller, J. E., Prasad, S. K., Jallo, J., Matias, C. M., Vaccaro, A. R., & Harrop, J. S. (2026). Durotomy Incidence in Degenerative Lumbar Spine Surgeries: A Systematic Review and Comparative Meta-Analysis of Proportions. Neurosurgery, 10.1227/neu.0000000000004255. Advance online publication. https://doi.org/10.1227/neu.0000000000004255
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
42847718
Department(s)
Administration and Leadership
Document Type
Article