Outcomes after incidental dural tears in spine surgery: a systematic review of MIS and OS cohorts

Background: Incidental dural tears (IDTs) are established complications in spinal surgery, yet the outcomes associated with early mobilization following IDTs differ between minimally invasive spine surgery (MISS) and open spine surgery (OSS), with limited clarity on best practices. Objective: This systematic review examines the differential outcomes of IDTs after MISS versus OSS, with a focus on hospital length of stay (LOS), rates of major and minor complications, and reoperation frequency. Methods: Following PRISMA guidelines, a comprehensive review of the literature was conducted across PubMed, Embase, and Cochrane databases through October 2022, with the quality of evidence evaluated per a modified version of Sackett’s Criteria. Twelve studies met the inclusion criteria, including 1 Level I study, 3 Level II studies, and 8 Level IV studies. Statistical comparisons were performed using unpaired t-tests and chi-squared tests to assess significance. Results: A total of 653 OSS patients (mean age 60.7 ± 3.5 years) and 179 MISS patients (mean age 61.6 ± 1.5 years), all mobilized within 24 hours were included. Dural repairs were performed in 95% of OSS cases and 98% of MISS cases. Although MISS patients experienced a shorter LOS (mean 2.0 ± 1.8 days) than OSS patients (mean 5.7 ± 2.9 days). Major complications were observed in 6.0% of OSS cases and 3.9% of MISS case, while minor complications were significantly reduced in MISS (2.2%) compared to OSS (6.0%). Although Dural repairs were performed in a similar percentage of patients in both groups (95% in OSS vs. 98% in MISS), the mean number of primary repairs per patient was significantly lower in the MISS group (3.5 ± 1.1) than in the OSS group (4.2 ± 1.3, p = 0.0283). This likely reflects fewer complex or multi-layered repairs needed in MISS, despite the high overall repair rate. Moreover, Reoperation rates were substantially lower in MISS (mean 5.6% ± 1.9%) relative to OSS (mean 8.5% ± 2.1%). The follow-up periods were statistically different between the OSS (10.5 ± 2.6 months) and MISS (9.1 ± 1.7 months) groups. Conclusion: MISS demonstrates potential significant benefits over OSS following IDT, with markedly lower minor complications and reoperation rates, as well as reduced need for primary repairs, and a trend toward shorter hospital stays.