Neurosurgical Fellow Mayo Clinic Rochester, Minnesota, United States
Introduction: Incidental durotomy is a common intraoperative complication during lumbar spine surgery. We aimed to assess the prevalence, risk factors, and effects of intraoperative incidental durotomy following spine surgery for lumbar spondylosis.
Methods: Patients receiving elective posterior lumbar spine surgery for degenerative spine disease were searched for in the Quality Outcomes Database. To determine the risk factors of inadvertent durotomy, backward stepwise logistic regression was used to develop a multivariable prediction model. The baseline differences between groups were corrected for using individual matching in a 3:1 ratio in order to evaluate the effect of durotomy on outcomes. These baseline characteristics comprised PROs, demographics, and preoperative neurological status. Interest-related outcomes were readmissions and reoperations after three months, as well as overall satisfaction, changes in the ODI scores, and pain scores.
Results: The prevalence of incidental durotomy in our total cohort was 2.3%, with the predictive model demonstrating a significantly high risk correlating with age, osteoporosis, lumbar spinal stenosis, preoperative ASA grade, revision surgery, number of operated levels, and lack of intraoperative arthrodesis of the spinal levels. The matched cohort consisted of 3,936 patients, with 984 patients suffering intraoperative durotomy, whereas the rest served as the control group. Significantly higher operative time(192.2 ± 101.4 vs. 148.4 ± 94.8 minutes, p < 0.01), length of stay (4.3 ± 13.0 vs. 2.3 ± 2.3 days, p < 0.01), and rates of readmissions (15.6% vs. 7.6%, p < 0.01) and reoperations (16.7% vs. 4.5%, p < 0.01) at three months were reported in patients with intraoperative durotomy. However, no significant difference was noted in patient satisfaction, pain scores, and ODI scores after three months of the surgery.
Conclusion : A higher number of levels treated, revision surgery, and lumbar spinal stenosis all raise the possibility of an accidental durotomy, among other factors. Although incidental durotomy does not alter patient satisfaction, it is linked to a higher risk of poor surgical outcomes regarding readmission and reoperation at three months after surgery.
