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Review Articles

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Intraoperative Management of Iatrogenic Durotomy in Endoscopic Spine Surgery: A Systematic Review
Neurospine. 2024;21(3):756-766.   Published online September 30, 2024
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Intraoperative Management of Iatrogenic Durotomy in Endoscopic Spine Surgery: A Systematic Review
Neurospine. 2024;21(3):756-766.   Published online September 30, 2024
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This review aims to systematically evaluate the incidence, management strategies, and clinical outcomes of iatrogenic durotomy (ID) in endoscopic spine surgery and to propose a management flowchart based on the tear size and associated complications. A comprehensive literature search was conducted, focusing on studies involving endoscopic spinal procedures and incidental durotomy. The selected studies were analyzed for management techniques and outcomes, particularly in relation to the size of the dural tear and the presence of nerve root herniation. Based on these findings, a flowchart for intraoperative management was developed. A total of 14 studies were included, encompassing 68,546 patients. Varying incidences of ID, with management strategies largely dependent on the size of the dural tear, were found. Small tears (less than 5 mm) were often left untreated or managed with absorbable hemostatic agents, while medium (5–10 mm) and large tears (greater than 10 mm) required more complex approaches like endoscopic patch repair or open surgery. The presence of nerve root herniation necessitated immediate action, often influencing the decision to convert to open repair. Effective management of ID in endoscopic spine surgery requires a nuanced approach tailored to the size of the tear and specific intraoperative challenges, such as nerve root herniation. The proposed flowchart offers a structured approach to these complexities, potentially enhancing clinical outcomes and reducing complication rates. Future research with more rigorous methodologies is necessary to refine these management strategies further and broaden the applications of endoscopic spine surgery.

Citations

Citations to this article as recorded by  Crossref logo
  • Disc Level–Specific outcomes of intradiscal condoliase injection for lumbar disc herniation: A multicenter retrospective study
    Kota Watanabe, Yohei Takahashi, Takehiro Michikawa, Takuya Takahashi, Tomohiro Banno, Kyohei Sakaki, Yoshiyasu Arai, Yuichi Takano, Yawara Eguchi, Yuki Taniguchi, Satoshi Maki, Yasuchika Aoki, Shunichi Fujii, Kentaro Sakaeda, Yu Matsukura, Tsutomu Akazawa
    Journal of Orthopaedic Science.2026; 31(3): 521.     CrossRef
  • Beyond the Microscope: Is Endoscopic Discectomy the Next Gold Standard for Lumbar Disc Herniation?
    Borriwat Santipas, Jin Sung Kim, Korawish Mekariya, John Y.S. Choi, Samuel K. Cho
    Neurospine.2026; 23(1): 61.     CrossRef
  • A Systematic Review of Complication Management During Uniportal and Biportal Endoscopic Spine Surgery: Dural Tear and Bleeding
    Siravich Suvithayasiri, Ju Eun Kim, Facundo Van Isseldyk, Marcus Serra, Christopher Martin, Viswanadha Arunkumar, Sotirios Veranis, Prashanth Rao, Enrico Giordan, Piya Chavalparit, Nelson Astur, Samuel Cho, Jin Sung Kim
    Global Spine Journal.2026;[Epub]     CrossRef
  • Classification of endoscopic spine procedures
    Mazda Farshad, Christoph J. Laux, Florian Wanivenhaus, José M. Spirig, Jonas Widmer, Michael Kelly, Javier Quillo-Olvera, Jin-Sung Kim, Facundo van Isseldyk, Sohrab Gollogly, James Yue, Xuexiao Ma, Vincent Hagel, Frédéric Cornaz
    North American Spine Society Journal (NASSJ).2025; 22: 100603.     CrossRef
  • Full-endoscopic dural repair using drain catheter: technical note
    Peter Van Daele, Piya Chavalparit, Borriwat Santipas, Jin-Sung Kim
    Acta Neurochirurgica.2025;[Epub]     CrossRef
  • Transdural rootlet herniation– An exceptional complication of full endoscopic lumbar discectomy: case reports and review of literature
    Kandarpkumar K. Patel, Siravich Suvithayasiri, Yanting Liu, Jin-Sung Kim
    European Spine Journal.2025; 34(10): 4455.     CrossRef
  • Intracranial Embolism After a Dural Tear in Endoscopic Spine Surgery
    Jae Won Shin, Si Young Park, Hak Sun Kim, Kyung Soo Suk, Seong Hwan Moon, Dong Hee Ye
    JBJS Case Connector.2025;[Epub]     CrossRef
  • Commentary on “Intraoperative Management of Iatrogenic Durotomy in Endoscopic Spine Surgery: A Systematic Review”
    Andrew J. Berg, Prashanth J. Rao
    Neurospine.2024; 21(3): 767.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the September 2024 Issue
    Inbo Han
    Neurospine.2024; 21(3): 743.     CrossRef
  • Practical Guidance of Full-Endoscopic Technique for Incidental Durotomy Repair: A Surgical Video Demonstration
    Warayos Trathitephun, Jackapol Kamolpak, Siravich Suvithayasiri
    Neurospine.2024; 21(4): 1102.     CrossRef
  • A Commentary on “Practical Guidance of Full-Endoscopic Technique for Incidental Durotomy Repair: A Surgical Video Demonstration”
    David Del Curto
    Neurospine.2024; 21(4): 1106.     CrossRef
  • Innovative Nerve Root Protection in Full-Endoscopic Facet-Resecting Lumbar Interbody Fusion: Controlled Cage Glider Rotation Using the GUARD (Glider Used As a Rotary Device) Technique
    Yu-Chia Hsu, Hao-Chun Chuang, Wei-Lun Chang, Yuan-Fu Liu, Chao-Jui Chang, Yu-Meng Hsiao, Yi-Hung Huang, Keng-Chang Liu, Chien-Min Chen, Hyeun-Sung Kim, Cheng-Li Lin
    Neurospine.2024; 21(4): 1141.     CrossRef
  • 9,865 View
  • 287 Download
  • 12 Crossref

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Concepts and Techniques to Prevent Cervical Spine Deformity After Spine Surgery: A Narrative Review
Neurospine. 2023;20(1):221-230.   Published online March 31, 2023
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Concepts and Techniques to Prevent Cervical Spine Deformity After Spine Surgery: A Narrative Review
Neurospine. 2023;20(1):221-230.   Published online March 31, 2023
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Adult cervical spine deformity is associated with decreased health-related quality of life, disability, and myelopathy. A number of radiographic parameters help to characterize cervical deformity and aid in the diagnosis and treatment. There are several etiologies for cervical spine deformity, the most common being iatrogenic. Additionally, spine surgery can accelerate adjacent segment degeneration which may lead to deformity. It is therefore important for all spine surgeons to be aware of the potential to cause iatrogenic cervical deformity. The aim of this review is to highlight concepts and techniques to prevent cervical deformity after spine surgery.

Citations

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  • Impact of T1 Slope as a Predictor of Loss of Cervical Lordosis and Health-Related Quality of Life after Laminoplasty in Patients with Ossification of the Posterior Longitudinal Ligament : A Retrospective Cohort Study
    Ji-Ho Jung, Jong-Hoon Jeong, Jong-Hwan Hong, Moon-Soo Han, Jung-Kil Lee
    Journal of Korean Neurosurgical Society.2026; 69(1): 124.     CrossRef
  • Comparison of cervical alignment between electromagnetic and traction-based head positioning systems
    Jonathan N. Sembrano, Dustin J. Kress, Regan Carlson, Jason J. Haselhuhn, Jacqueline E. Wright, Paul Brian O. Soriano, Kari Odland
    World Neurosurgery: X.2026; 31: 100595.     CrossRef
  • The Variability of the Cervicothoracic Inflection Point: A Cohort Analysis of the Multi-Ethnic Asymptomatic Normative Study (MEANS)
    Justin L. Reyes, Roy Miller, Matan Malka, Josephine Coury, Yong Shen, Natalia Czerwonka, Alexandra Dionne, Jean-Charles Le Huec, Stephane Bourret, Kazuhiro Hasegawa, Hee Kit Wong, Gabriel Liu, Hwee Weng Dennis Hey, Hend Riahi, Michael Kelly, Lawrence G. L
    Global Spine Journal.2025; 15(4): 2409.     CrossRef
  • Commentary: Cervicothoracic Deformity in the Setting of Adhesive Arachnoiditis: An Operative Video Article
    Ranbir Ahluwalia, Harsh Jain, Scott L. Zuckerman
    Operative Neurosurgery.2025; 29(1): 158.     CrossRef
  • Risk factors associated with distal junctional kyphosis and failure after surgical management of adult cervical deformity: a systematic review
    Davin C. Gong, Anthony N. Baumann, Zhaorui Wang, Omkar S. Anaspure, Muhammad Waheed, Evan J. Beck, Rakesh D. Patel, Ilyas S. Aleem
    European Spine Journal.2025; 34(8): 3430.     CrossRef
  • Long-term loss of intervertebral disc height after posterior cervical surgery for ossification of the posterior longitudinal ligament: a retrospective study with more than 3 years of follow-up
    Siyuan Qin, Ruomu Qu, Weili Zhao, Ruixin Yan, Yongye Chen, Feifei Zhou, Ning Lang
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • 10,140 View
  • 275 Download
  • 8 Web of Science
  • 6 Crossref

Case Reports

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Chin on Chest Deformity Caused by Upper Cervical Kyphosis Associated With Ankylosing Spondylitis: A Case Report
Neurospine. 2020;17(3):666-671.   Published online September 30, 2020
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Chin on Chest Deformity Caused by Upper Cervical Kyphosis Associated With Ankylosing Spondylitis: A Case Report
Neurospine. 2020;17(3):666-671.   Published online September 30, 2020
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Chin on chest deformity caused by upper cervical kyphosis associated with ankylosing spondylitis is rare. A 66-year-old woman presented at our institute with chief complaints of difficulty in horizontal gaze and opening her mouth. Cervical radiographs showed a C0–2 angle of 1° on flexion and 7° on extension, and her chin-brow vertical angle was 49°. We planned fixation surgery at C0–5 posteriorly to prevent the progression of kyphosis, with slight correction of the kyphosis at C0–2. The correction was performed by pushing down the over lordotically contoured titanium rods connected to an occipital plate onto the C3–5 lateral mass screws, just like cantilever technique. No palpable cracking or loss of resistance was noticed during the correction. However, intraoperative radiographs revealed apparent anterior separation of the vertebral bodies between C3 and C4. Postoperative computed tomography images at the C3/4 level suggested hemorrhage from the fracture site. Tracheostomy was performed because of massive edema around the pharynx. To secure solid bone fusion, staged surgery to extend the fusion to T3 and to graft an additional iliac bone was performed. Fortunately, the C2–7 angle was corrected to 40°, and her chin-brow vertical angle was restored to 17° without any catastrophic complications. Although the patient finally obtained an ideal sagittal alignment, the surgeon should be aware that the technique had a higher perioperative risk for iatrogenic fracture, resulting in neurological and vascular injuries.

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  • Understanding Radiographic Parameters in Cervical Deformity
    Max Fisher, Oluwatobi O. Onafowokan, Kyriakos Chatzis, Peter Tretiakov, Peter G. Passias
    Clinical Spine Surgery.2025; 38(9): 404.     CrossRef
  • Surgical management of idiopathic acute cervical kyphosis; A case-based review of an extremely rare entity
    Seyed Amir H. Javadi, Mohammad Mirahmadi Eraghi, Arad Iranmehr, Zahid Hussain Khan, Abolfazl Rahimizadeh
    International Journal of Surgery Case Reports.2024;[Epub]     CrossRef
  • Iatrogenic Fracture in a Patient of Ankylosing Spondylitis Planned for Surgical Correction of Chin-on-Chest Deformity
    Saumyajit Basu, Kushal Gohil, Ashish Gupta, Jallipalli Ranga Sai Gowtham, Dheeraj Manikanta, Gokul Bandagi, Amitava Biswas
    Indian Spine Journal.2022; 5(2): 231.     CrossRef
  • 10,101 View
  • 180 Download
  • 2 Web of Science
  • 3 Crossref

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Iatrogenic Intraspinal Epidermoid Cyst
Korean J Spine. 2014;11(3):195-197.   Published online September 30, 2014
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Iatrogenic Intraspinal Epidermoid Cyst
Korean J Spine. 2014;11(3):195-197.   Published online September 30, 2014
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Epidermoid cyst is generally regarded as congenital disease, and commonly related to other congenital spinal anomalies. However, it also develops iatrogenically. We report one rare case of epidermoid cyst that we experineced among intradural extramedullary tumors. A 21-year-old female patient was admitted to the hospital due to low back pain with radiating pain into a right lower extremity that initiated about a month ago. She complained sensory lose and motor weakness (grade 4+) on her right extremity as well as urinary dysfunction and sphincter dysfunction. She had a lumbar puncture three times due to Pneumococcal meningitis when she was 13 years old. The well-circumscribed intradural extramedullary mass of 1.8×1.6×4 cm size was found on the L4-5 in a magnetic resonance image. Gross total tumor removal was garried out after the total laminectomy L5 and partial laminectomy L4. The tumor mass was gray-colored and so fragile that it was easy to be removed. The histological diagnosis confirmed epidermoid cyst without malignancy. After the operation, the patient progressively showed remarkable neurological recovery. In this case, the cause of epidermoid cyst is considered iatrogenic concerning history of several times of lumbar puncture as meningitis.

Citations

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  • Idiopathic intradural extramedullary epidermoid cyst at the conus medullaris
    Berkay Bozkurt, Halit Alioglu, Mahmoud Osama, Mert Yavuz, Zuhal Kuş Silav, Baris Ozoner
    Interdisciplinary Neurosurgery.2026; 43: 102184.     CrossRef
  • A rare isolated intradural extramedullary epidermoid cyst of the thoracic spine: A case report and literature review
    Niventhiran Kuppusamy, Karthik Ramachandran, Gnanaprakash Gurusamy, Ajoy Prasad Shetty, Shanmuganathan Rajasekaran
    Journal of Orthopaedic Reports.2025; 4(1): 100576.     CrossRef
  • Intradural extramedullary spinal epidermoid cyst: a narrative review of predisposing factors, surgical challenges, and outcomes
    Shahidul Islam Khan, Nazmin Ahmed, Erfanul Haque Siddiqi, Mahamud Mannan, Forhad Sheikh, Kamrul Ahsan, Daniel Encarnacion Santos, Ahsan Majid, Jamal Uddin Ahmed, Ali Noor, Bipin Chaurasia
    Annals of Medicine & Surgery.2025; 87(11): 7440.     CrossRef
  • Asymptomatic intraspinal epidermoid cyst in a 7-year-old male with juvenile idiopathic arthritis identified by an advanced physiotherapist practitioner: a case report
    Julie Herrington, Michelle Batthish, Heba Takrouri, Blake Yarascavitch, Anita Gross
    Journal of Manual & Manipulative Therapy.2024; 32(3): 343.     CrossRef
  • Optimizing Surgical Outcomes for Intracranial Epidermoid Tumors: A Retrospective Analysis of Clinical Predictors, Surgical Decisions, and Patient Clustering
    Mychael W. Delgardo, Damian E. Teasley, Anthony J. Tang, Chiemela Izima, Brianna M. Peet, Andrés Pascual-Leone, Geoffrey Reeves, Brett E. Youngerman, E. Sander Connolly, Guy M. McKhann, Jeffrey N. Bruce, Neil A. Feldstein, Peter Canoll, Michael B. Sisti
    World Neurosurgery.2024; 190: e931.     CrossRef
  • An unusual late complication of peridural anesthesia: The case of a subdural spinal epidermoid cyst: A case report and literature review
    DIOP Abdoulaye, LIMI Jihane, SAMBOU Natacha, JIHED Mortada, ROBIN Srour
    Asian Journal of Oncology.2024; 10: 15.     CrossRef
  • Tumori spinali intradurali
    S. Diabira, A. Akhaddar
    EMC - Neurologia.2022; 22(3): 1.     CrossRef
  • Intraspinal dermoid and epidermoid cysts: Long-term outcome and risk factors
    Xin Wang, Jun Gao, Tianyu Wang, Zhimin Li, Yongning Li
    The Journal of Spinal Cord Medicine.2020; 43(4): 512.     CrossRef
  • Spinal Intramedullary Epidermoid Cyst: Case Report and Updated Literature Review
    Octavian-Mihai Sîrbu, Alin-Vasile Chirteş, Marian Mitricã, Carmen-Adella Sîrbu
    World Neurosurgery.2020; 139: 39.     CrossRef
  • Possible Double Crush Syndrome Caused by Iatrogenic Acquired Lumbosacral Epidermoid Tumor and Concomitant Sacral Tarlov Cyst
    Yusuke Nishimura, Masahito Hara, Takayuki Awaya, Ryo Ando, Kaoru Eguchi, Yoshitaka Nagashima, Toshihiko Wakabayashi, Howard J. Ginsberg
    NMC Case Report Journal.2020; 7(4): 195.     CrossRef
  • Intradural iatrogenic epidermoid cyst at cauda equina: A case report
    Jose Javier Cuellar Hernandez, Miracle Anokwute, Silvia Judith Hernandez Martinez, Jose Ramon Olivas
    Surgical Neurology International.2020; 11: 299.     CrossRef
  • Epidermal Inclusion Cyst Formation After Barbed Thread Lifting
    Sang Oon Baek, Jeonghwan Shin, Jun Yong Lee
    Journal of Craniofacial Surgery.2020; 31(5): e493.     CrossRef
  • Intraspinal Inclusion Tumor After Myelomeningocele Repair: A Long-Term Single-Center Experience
    Pietro Fiaschi, Gianluca Piatelli, Armando Cama, Valeria Capra, Alessandro Consales, Marcello Ravegnani, Marco Pavanello
    World Neurosurgery.2019; 122: e1338.     CrossRef
  • Lumbar laminotomy and replantation for the treatment of adult spinal epidermoid cyst
    Yong-Peng Lin, Yong-Jin Li, Bo-Lai Chen, Yu-Hai Guo
    Medicine.2018; 97(1): e9334.     CrossRef
  • Spinal Epidermoid Tumors: Case Report and Review of the Literature
    Vivek B. Beechar, Pascal O. Zinn, Kent A. Heck, Gregory N. Fuller, Inbo Han, Akash J. Patel, Alexander E. Ropper
    Neurospine.2018; 15(2): 117.     CrossRef
  • Repeated recurrent epidermoid cyst with atypical hyperplasia
    Jialin Li, Ming Qian, Xiaoyi Huang, Li Zhao, Xinghai Yang, Jianru Xiao
    Medicine.2017; 96(49): e8950.     CrossRef
  • Thoracic Intradural-Extramedullary Epidermoid Tumor: The Relevance for Resection of Classic Subarachnoid Space Microsurgical Anatomy in Modern Spinal Surgery. Technical Note and Review of the Literature
    Giuseppe M.V. Barbagallo, Massimiliano Maione, Giuseppe Raudino, Francesco Certo
    World Neurosurgery.2017; 108: 54.     CrossRef
  • Extraparenchymal Lesions in Adults
    Marta Drake-Pérez, James G. Smirniotopoulos
    Neuroimaging Clinics of North America.2016; 26(4): 621.     CrossRef
  • Extensive Intradural Epidermoid Cysts with Cauda Equina Syndrome in the Lumbosacral Spine: Case Report
    Tae-Keun Ahn, Dong-Eun Shin, Young Woo Kwon, Sang-June Lee
    Journal of Korean Society of Spine Surgery.2016; 23(2): 121.     CrossRef
  • Extensive Intradural Epidermoid Cysts with Cauda Equina Syndrome in the Lumbosacral Spine: Case Report
    Tae-Keun Ahn, Dong-Eun Shin, Young Woo Kwon, Sang-June Lee
    Journal of Korean Society of Spine Surgery.2016; 23(2): 121.     CrossRef
  • 9,138 View
  • 70 Download
  • 20 Crossref

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Common Iliac Vessel Injury after Lumbar Discectomy.
Korean J Spine. 2011;8(3):229-231.
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Common Iliac Vessel Injury after Lumbar Discectomy.
Korean J Spine. 2011;8(3):229-231.
Close
Injury of common iliac vein related to lumbar discectomy is a rare complication. We report a patient who sustained injury of common iliac vein during lumbar discectomy for extraforaminal lumbar herniated disc. In this case, she had hypovolemic shock due to massive bleeding, and underwent emergent interventional treatment and open laparatomy. Although the vascular injuries were successfully repaired, it could be a fatal complication. We report the clinical features and early management, emphasizing the need for rapid diagnosis, immediate intervention and treatment for favorable outcome.

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  • Iatrogenic Vascular Injury Occurring during Discectomy in a Spondylodiscitis Patient
    Do Hyun Kim, Tae Wan Kim, Min Ki Kim, Kwan Ho Park
    Korean Journal of Neurotrauma.2016; 12(2): 171.     CrossRef
  • 4,488 View
  • 35 Download
  • 1 Crossref