gms | German Medical Science

Objective: Incidental durotomy (ID) seem to be the most common complication in lumbar disc herniation- and decompression surgery. We therefore evaluate risk factors, therapy strategies and clinical outcome in patients with lumbar disc herniation surgery and in lumbar decompression surgery for spinal stenosis.

Methods: All patients in the period from 1/2013 to 12/2015 with lumbar disc herniation surgery and lumbar decompression surgery for lumbar spinal stenosis at our institution were reviewed retrospectively. Age, gender, co-morbidities, body mass index (BMI), neurostatus, surgery-time and -procedure, strategies of dural repair in case of ID (suture, fibrin glue, fat patch or lumbar drainage) and hospital-stay overall as well as patients outcome (Odom’s criteria) were assessed. Two groups - patients with ID in lumbar disc herniation surgery (group 1) and patients with ID in decompression surgery for lumbar spinal stenosis (group 2) - were formed.

Results: In total 509 patients with lumbar disc herniation surgery and 438 patients with lumbar decompression surgery could identified. In group 1 ID occurred in 35 patients (6.87%) operated on lumbar disc herniation. Mean patient age was 57 (29-77) years and 57% of the patients were male. The BMI in this group was 27 ± 6 kg/m². Operation procedure time was 121 ± 39 minutes. In 23 operations the dural lesion was covered with Tachosil™, fibrin glue or fat-patches, only in 12 cases additional sutures were necessary. No lumbar drainage was necessary. 11 patients (31%) had a previous lumbar spine surgery before. After mean hospital stay of 9 days 34 patients with improvement of complaints were discharged at home. 2 months follow up evaluation showed in 81% a fair or better post-operative result and no signs or symptoms of dural leakage.In group 2 ID occurred in 23 patients (5.25%) operated with decompression surgery for lumbar spinal stenosis. Mean patient age was 76 (60-84) years and 48% of the patients were male. The BMI in this group was 30 ± 5 kg/m². Operation procedure time was 158 ± 53 minutes. In 18 operations the dural lesion was closed with sutures and covered with Tachosil™, fibrin glue or fat-patches. A lumbar drainage application was not necessary. 4 patients (17%) had a previous lumbar spine surgery before. After mean hospital stay of 10 days all patients with improvement of complaints were discharged at home. 2 months follow up evaluation showed in 87.5% a fair or better result. Signs or symptoms of dural leakage were not presented.

Conclusion: ID in lumbar disc herniation surgery and in decompression surgery for lumbar spinal stenosis can be safely performed with and without suture repair. An elevated BMI and previous lumbar spine surgery can increase the risk of incidental durotomy.