Dural Tears in Endoscopic Spine Surgery: Incidence, Risk Factors, Prevention, and Management.

Dural tear risk in endoscopic spine surgery is determined more by procedural complexity and surgeon experience than by the endoscopic technique alone, with the highest rates observed in interlaminar decompression for lumbar stenosis and the lowest in transforaminal procedures. Most incidental dural tears can now be managed endoscopically without routine conversion to open surgery, particularly when tears are recognized early and stratified according to size, location, cerebrospinal fluid flow, and neural element involvement. Patch- and graft-based techniques represent the current workhorse strategy for moderate dural tears (5-10 mm), whereas endoscopic suturing is increasingly feasible for larger or high-flow defects in experienced hands. There is currently no standardized postoperative management protocol for endoscopic dural tears, and practices regarding bed rest, mobilization, and drain usage remain highly variable across the literature. The clinical significance of dural tear is determined less by its occurrence than by the adequacy of its management as most patients achieve favorable long-term outcomes when tears are recognized and treated appropriately.