Incidental durotomy is a complication of spinal surgery that carries a risk of persistent CSF leak. One major concern with persistent CSF leakage is the increased risk of infection.

Fifty-six consecutive patients who underwent spine surgery complicated by incidental durotomy between 2017 and 2022. We compared 28 patients who developed a postoperative infection (IG) and 28 patients who did not (CG).

The median age was 40.6 years in the IG and 57.7 years in the CG (p = 0.04). The index procedures were decompression for stenosis or discectomy for herniated disc; 18 patients had associated instrumentation. The incidental durotomy was watertightly repaired intraoperatively in 23 patients (82.1%) in the CG and 24 patients (85.7%) in the IG (p = 0.469). A meningocele developed in 64.3% of patients in the CG versus 39.3% in the IG (p = 0.310). Mean time to detectable CSF leak was 5.2 days (SD 3.3) in the CG and 11.8 days (SD 3.7) in the IG (p = 0.01). Multivariable logistic regression identified postoperative hematoma (OR 0.541, 95% CI 0.023–0.900, p = 0.03) and delayed CSF leak (OR 0.069, 95% CI 0.006–0.808, p = 0.03) as independent risk factors for infection after incidental durotomy. Conversely, use of a postoperative compressive dressing (OR 6.379, 95% CI 0.283–143.5, p = 0.04) was associated with decreased infection risk.

To reduce the risk of infection after incidental durotomy, meticulous hemostasis is important to prevent postoperative hematoma formation. We recommend applying a compressive dressing for at least 48 hours postoperatively.