STUDY DESIGN: A retrospective review of 20 patients with incidental durotomy 
treated without mandatory bed rest.
OBJECTIVES: To determine whether patients with incidental durotomy can be 
treated effectively without multiple days of bed rest.
SUMMARY OF BACKGROUND DATA: Incidental durotomy can cause postural headaches, 
nausea, vomiting, dizziness, photophobia, tinnitus, and vertigo. These symptoms 
are believed to result from a decrease in cerebrospinal fluid pressure, leading 
to traction on the supporting structures of the brain. Traditional management 
includes bed rest for up to 7 days to eliminate traction and reduce hydrostatic 
pressure during the healing process.
METHODS: Twenty incidental durotomies were repaired intraoperatively with dural 
stitches and fibrin glue. Patients were allowed to ambulate according to the 
natural course after surgery without mandatory bed rest. Symptoms were monitored 
closely for 1 week, and long-term follow-up assessments were obtained at a 
minimum of 10 months.
RESULTS: Of the 20 patients in this study, 75% had no symptoms after repair of 
the incidental durotomy. Each of the dural tears was 1-3 mm in length. Two 
patients reported headache, two reported nausea, and one reported tinnitus; no 
patients experienced vomiting. One patient (5%) had stitch loosening requiring 
revision surgery. There were no additional serious complications.
CONCLUSIONS: This study has shown that the majority of patients with incidental 
durotomy can be treated effectively with dural stitches and fibrin glue. 
Patients can be permitted to ambulate immediately after surgery but should be 
cautioned to lay flat if they develop symptoms. This will reduce the costs 
related to the hospital stay and missed work.