gms | German Medical Science

Objective: Incidental durotomy (ID) is an unpleasant, but common complication of spinal surgery. Only few studies examined the impact on patients after Ids. Reported outcomes varies from no effect on the morbidity to increase tendency for worsening outcomes including a tendency toward more revisions, neurological deficits and longer durations of inability to work. The aim of this study was to evaluate the long-term results of ID of the elderly.

Method: In a period of 5 years, 8851 patients underwent spinal surgery. ID occurred in 416 patients during different spinal surgical procedures. In the presented study, 116 patients agreed to participate. A long-term outcome analysis was assessed by telephone survey using the Oswestry Low Back Pain Disability Index and patient outcome survey. The mean long-term follow-up was 29.5 months (range 6-42 months).

Results: In 115 patients (99.1%) ID occurred during lumbar spine and in one patient (0.9%) during thoracic spine surgery. 57 Patients (49.1%) reported excellent or good results, 23 Patients (19.8%) were evaluated with moderate disability, 22 patients (19%) with severe disability and 14 patients (12%) were found to be crippled. 26 patients (22.4%) needed to be admitted again to hospital because of residual symptoms related to ID. The patients were classified into 3 groups depending on the post-ID period: 22 patients (19%) experienced ID before one-year, 41 patients (35.3%) experienced ID for more than one year but less than 3 years, 35 patients (30%) experienced ID for more than 3 years. A significant relation was found between longer post-ID period and less disability level of patients (p <0.05). Patients were defined into 3 age groups: 14 patients were less than 60 years old, 79 patients were from 60 years and less than 80 years old and 23 patients were older than 80 years. There was no significant difference between the age groups.

Conclusions: The presented long-term outcome study shows that ID is associated with disability, residual symptoms and functional limitations in the elderly. There is a significant relationship between improvement of outcome and longer postoperative time after ID.