Keep Patients with Dural Tears Flat for 24–48 Hours
Jayme E. Locke MD
Dural tear is a known complication of spinal surgeries, such as laminectomies, spinal fusions, and disc excisions. It most commonly occurs in the lumbar region. In general, the tear is noted at the time of operation when leakage of cerebrospinal fluid (CSF) is noted by the surgeon. A tear in the dura results in decompression of the thecal sac and reduction of local pressure on the epidural veins, allowing CSF to leak in to the operative site. Dural tears that are not noted at the time of surgery often present in the postoperative period. Patients manifest severe headaches that are exacerbated by upright posture. In addition, CSF can be seen leaking from the wound, or a subcutaneous collection may be noted. Confirmation that the fluid is CSF can be gained by testing the fluid for beta-2 transferrin.