Incidence, risk factors, and treatment of incidental durotomy during decompression in degenerative lumbar spine conditions.

ABSTRACT

BACKGROUND: The purpose of this study was to identify independent risk factors for incidental durotomy (ID) during decompressive lumbar spine surgery, and to describe its treatment. METHODS: This retrospective review includes 650 patients who underwent lumbar decompression at a tertiary institution between January 2015 and October 2019. Data collection was obtained through one independent researcher. The incidence rate and treatment of ID was evaluated by a chart review of operative notes, patient charts, physiotherapy reports, and nursing reports. RESULTS: The incidence rate of ID was 12.6%. The most common reason for admission was disc herniation (63.2%), followed by vertebral stenosis (22.1%). ID resulted in significantly longer operation time (P=0.0001) and length of hospitalization (P=0.0001). A correlation between ID and patient's diagnosis (P=0.0078) as well as the chosen type of surgery (P=0.0404) with an Odds Ratio to cause ID of 1.9 for laminectomy and 1.6 for undercutting compared to microdiscectomy were found. However, age, sex, surgeon experience, lumbar level, revision surgery, as well as multilevel surgery were not significantly correlated with the incidence of ID. Dural tears were closed with dural sealant (47.2%), polyester 4-0 sutures (11.1%) or a combination of both (37.5%) and the majority of patients had bed rest of at least two days. By usage of these treatment methods no patient needed reoperation. CONCLUSIONS: Diagnosis of vertebrostenosis as well as laminectomy were significantly correlated with the incidence of ID. Treatment with intraoperative closure and postoperative bed rest even though not standardized led to complication free outcomes.