Multiple Nerve Root Injuries after Incidental Durotomy: Case Report with Anatomical Correlation and Review of Literature

CSF leak is one of the most common complications in primary spine surgery. It is even more common in revision surgery. Its causes are multifactorial. It is usually a benign process, but at times it can lead to nerve injury. There have been a number of case reports regarding diagnosis and treatment of spinal nerve injuries due to incidental durotomies. However, they involve either single nerve root or ipsilateral nerves of the cauda equina that were trapped in the durotomy. We present a case of a morbidly obese patient who underwent discectomy for recurrent lumbar disc herniation. During the revision surgery, we encountered a small incidental durotomy through which a significant number of nerve roots exited and as a result were injured. This resulted in bilateral nerve dysfunction, which is a unique aspect of our case presentation. We will discuss the anatomical and pathophysiological bases for this injury. We will also review the literature regarding outcomes after incidental durotomies in regard to spinal nerve injuries.