Risk factors for dural tears following spinal surgery: A quantitative analysis of 33 cohort studies involving 831,292 participants.

Dural tear (DT) is a common intraoperative complication of lumbar and other spinal surgeries. Although interest in its potential risk factors has increased in recent years, the overall incidence of DT and its definitive predictors remain incompletely understood. This study aimed to comprehensively identify risk factors associated with DT following spinal surgery through a systematic review and meta-analysis. A systematic search of PubMed, Embase, and the Cochrane Library was conducted from database inception to July 26, 2025, to identify studies reporting risk factors for DT after spinal surgery. Random-effects models were used to calculate pooled odds ratios (ORs) for each potential predictor. Based on sample size, Egger’s test, and between-study heterogeneity, the quality of evidence from observational studies was categorized as high (Class I), moderate (Class II or III), or low (Class IV). Subgroup analyses stratified by baseline study characteristics and leave-one-out sensitivity analyses were performed to further explore heterogeneity and assess the robustness of the findings. Of 18,255 screened records, 33 cohort studies comprising 831,292 patients were included in the quantitative synthesis. Among patient-related factors, advanced age (≥ 60 years) (OR, 1.05; 95% CI, 1.00–1.10, P = 0.04), female sex (OR, 1.42; 95% CI, 1.28–1.57, P < 0.01), lumbar spinal stenosis (LSS) (OR, 1.77; 95% CI, 1.39–2.27, P < 0.01), hypertension (OR, 1.34; 95% CI, 1.12–1.59, P < 0.01), and diabetes mellitus (OR, 1.35; 95% CI, 1.12–1.62, P < 0.01) were associated with increased DT risk. Among surgery-related factors, revision procedures (OR, 2.78; 95% CI, 2.24–3.45, P < 0.01) and laminectomy (OR, 1.94; 95% CI, 1.43–2.64, P < 0.01) were significant predictors. The meta-analysis indicated that smoking and microendoscopic discectomy (MED) were not independent risk factors for DT after spinal surgery. This meta-analysis identifies advanced age, female sex, hypertension, diabetes, and LSS as key patient-related risk factors for DT, while revision surgery and laminectomy are important surgical predictors. However, given the modest effect sizes observed for most variables, these findings should be interpreted with caution. Additional prospective studies are warranted to strengthen the evidence base. Despite these limitations, the results may assist clinicians in recognizing high-risk patients and improving perioperative management.