Incidental Durotomy in Degenerative Lumbar Spine Surgery – A register study of 64,431 operations

Publication date: Available online 30 August 2018

Source: The Spine Journal

Author(s): Fredrik Strömqvist, Freyr Gauti Sigmundsson, Björn Strömqvist, Bo Jönsson, Magnus K. Karlsson

Abstract

Background

Incidental durotomy (ID) is one of the most common intraoperative complications seen in spine surgery. Conflicting evidence has been presented regarding whether or not outcomes are affected by the presence of an ID.

Purpose

To evaluate whether outcomes following degenerative spine surgery are affected by ID and the incidence of ID with different diagnoses and different surgical procedures.

Material

By using SweSpine, the national Swedish Spine Surgery Register, preoperative, surgical and postoperative 1 year follow up data were obtained for 64,431 surgeries. All patients were surgically treated due to spinal stenosis (LSS) without or with concomitant degenerative spondylolisthesis (DS) or lumbar disc herniation (LDH) between 2000-2015. Gender, age, smoking habits, walking distance, consumption of analgesics, back and leg pain (VAS), quality of life (EQ5D, SF-36) and disability (ODI) were recorded.

Results

Overall, incidence of ID during the study period was 5.0%. For the LDH, LSS, and DS subgroups it was 2.8%, 6.5%, and 6.5%, respectively. Laminectomy was associated with higher incidence of ID than discectomy (p<0.001). ID was more common in all three subgroups if the patient had previously been subjected to spine surgery and with increasing age of the patients (p<0.001). LDH patients with an ID reported a higher degree of residual leg pain, inferior mental quality of life (SF-36 MCS) and higher disability (ODI) than LDH patients without ID (all p<0.001) one-year after surgery. LSS patients with an ID reported inferior SF-36 MCS (p<0.001) and DS patients with an ID had inferior SF-36 MCS and higher ODI compared to patients with the same diagnosis but without an ID (p<0.001). However, these numerical differences are well below references for MCID, for all 3 subgroups. ID was associated with a higher frequency of patients being dissatisfied with the surgical outcome at one year follow up. In patients who did not improve in back-and leg pain following surgery (delta-value), ID was less common than in patients reporting improved back- and legpain from before as compared to following surgery.

Conclusions

The overall occurrence of ID in the present study was 5%, with higher figures in LSS and DS and lower figures in LDH. Higher age of the patient and previous surgery was associated with higher frequencies of ID. The outcome at one year following surgery was not affected to a clinically relevant extent when an ID. However, ID was associated with a higher degree of patient dissatisfaction and a longer hospital length of stay.

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