January 4, 2019

Freshman medical student publishes survey to determine how spinal surgeons treat dural tears

A student at the Wayne State University School of Medicine has published his second survey of spinal surgeons since starting medical school last year.

Arif Musa is a first-year medical student who asked spine surgeons what methods they use to manage intraoperative dural tears - tears in the outermost membrane that surrounds the spinal cord.

"This is the most common complication of spine surgery and is routinely identified during the operation and treated by the surgeon during the procedure itself. However, even though it is an extremely common complication, there is no accepted set of guidelines for its management," Musa said.

He surveyed surgeons from AO Spine North America last summer about their preferences. "Preferences of Spine Surgeons with Regard to Management of Intraoperative Durotomy: A Survey of Current Management" was published in the October 2018 issue of the journal Clinical Spine Surgery.

Of 217 respondents, 70 percent were orthopedic surgeons, half practiced at an academic center and 70 percent operated on 100 to 300 patients per year. The most preferred techniques intraoperatively were sutures and application of sealant to the dural tear. Postoperatively, the most preferred management technique was to recommend bed rest. When compared between decompression and spinal fusion surgeries, the management preference did not vary. Most North American spine surgeons responding preferred to manage dural tears with sutures, sealant and bed rest, although other techniques continue to be used, and preferences do not change based on the type of surgery (decompression versus spinal fusion).

"Wayne State University School of Medicine does an excellent job of immersing students in clinical decision-making from the first day of classes. This immersion forces students to grapple with difficult questions when it comes to patient care, thereby preparing them for the variety of clinical scenarios they will experience during rotations and beyond," Musa said. "By researching intraoperative dural tears, I hoped to identify the most employed techniques for management of one of the most common complications of spine surgery. Researching dural tears has given me an opportunity to try to learn how physicians react to common complications. The results of my study have also indicated that there is often great variation in clinical decision-making, underscoring the importance of self-directed learning and routinely employing evidence-based practice."

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