ABS 025: Primary Sutured Versus Non-Sutured Repair of Incidental Durotomy During Lumbar Spine Surgery: A Retrospective Cohort Study of Postoperative Cerebrospinal Fluid–Related Complications

Rithikaa Rajendran BA ¹ ⁴, Adriana Bayron BA ², Ilona Cazrola Morales MD ³, Yevgenia Shekhtman MD ⁴

¹ Department of Neuroscience, Rutgers University
² Hackensack Meridian School of Medicine
³ Westchester Medical Center, Valhalla NY.
⁴ Department of Neurosurgery, HMH Neuroscience Institute, JFK Medical Center​

The Van Wickle Journal (2026) Volume 2, ABS025

Introduction: Incidental durotomy is a common complication of lumbar spine surgery and is associated with postoperative cerebrospinal fluid (CSF) leak, pseudomeningocele formation, wound complications, and reoperation. Surgeons generally manage these tears using either primary sutured closure or non-sutured techniques such as sealants or grafts, though the optimal repair strategy remains debated. This study compares postoperative outcomes associated with primary sutured versus non-sutured closure techniques following incidental durotomy.

Methods: A retrospective review of spinal surgeries performed between 2019 and 2025 at a neurosurgical center was conducted to identify cases with documented incidental durotomy. Exclusion criteria included procedures removed prior to electronic medical record updates, patients younger than eighteen years, inaccessible operative documentation, and surgeries without exposure of the thecal sac. Of 1,884 procedures screened, 1,047 met eligibility criteria. After additional exclusions, 104 cases referenced durotomy, and 99 confirmed incidental durotomies were included for analysis. Patients were categorized by repair technique into primary sutured and non-sutured closure groups. Outcomes assessed included postoperative CSF leak, pseudomeningocele, wound complications, positional headache, neurological deficit, readmission, reoperation, and CSF diversion. Statistical analysis was performed using Fisher’s exact test and odds ratios with 95% confidence intervals.

Results: Among 99 confirmed incidental durotomies, 61 underwent primary sutured closure and 38 underwent non-sutured repair. L4 and L5 were the most commonly involved levels. Non-sutured repair demonstrated higher rates of postoperative complications, including pseudomeningocele (21.1% vs 3.3%, p = 0.0064), postoperative CSF leak (21.1% vs 3.3%, p = 0.0064), and positional headache (23.7% vs 6.6%, p = 0.02865). Wound dehiscence was also more frequent in the non-sutured group (18.4% vs 8.2%), although this difference was not statistically significant (p = 0.20). Overall, primary sutured closure was associated with fewer CSF-related postoperative complications compared with non-sutured repair techniques.

Discussion: Non-sutured repair techniques were associated with increased postoperative CSF-related complications compared with primary sutured closure. These findings support the use of primary sutured repair when technically feasible to reduce complications such as CSF leak, pseudomeningocele, and positional headache. Given the retrospective design and variability in operative decision-making, further prospective studies are needed to better define optimal management strategies for incidental durotomy in lumbar spine surgery.