ABSTRACT
Intraoperative incidental durotomies may occur in as many as 1% of cervical spine surgeries. The expectation of treatment is healing of the dural tear with resolution of the symptoms. The only strong contraindication for surgical intervention in cases of a severe persistent cervical dural tear is a medical condition that would not allow the patient to be treated safely under general anesthesia. The operative team may also benefit from having a kit for placement of a subarachnoid drain in the event that cerebrospinal fluid diversion is required. Introperative spinal cord monitoring with SSEM and motor-evoked potentials may be helpful in confirming that the operative position is tolerated by the patient and that the spinal cord function remains intact through the surgical intervention. Additionally, symptoms of meningitis should also be sought. The factors should be emphasized during the treatment of a persistent cervical dural tear: watertight closure, tight wound closure, upright positioning, and optimal nutrition.
