Takenaka S, Makino T, Sakai Y, et al. - A total of 12,171 patients with degenerative lumbar diseases underwent primary lumbar spine surgery between 2012 and 2017 in order to investigate risk factors for complications related to dural tear (DT), including the types of DT, and the intra- and postoperative management of DT. In total, a DT was noted in 429/12,171 patients. Multivariable analysis exhibited that polyethylene glycol (PEG) hydrogel significantly decreased the incidence of dural leak and prolonged bed rest, and that patients treated with sealants (fibrin glue and PEG hydrogel) significantly less often suffered from headache. A longer drainage term significantly rose the incidence of headache, nausea/vomiting, and delayed wound healing. In younger female patients, headache and nausea/vomiting were significantly more common. Postoperative neurological deficit and reoperation for DT was significantly dependent on the presence of cauda equina/nerve root herniation. The only independent risk factor for surgical site infection was a longer operative time, which was also a risk factor for dural leak, prolonged bed rest, and nausea/vomiting. Thus, in decreasing symptoms associated with cerebrospinal fluid leakage, sealants, especially PEG hydrogel, could be beneficial, whereas prolonged drainage may not be needed. Moreover, when DT occurs, younger female patients should be cautiously treated.