gms | German Medical Science

Objective: The purpose of this study was to identify independent risk factors for incidental durotomy (ID) during one of the most common lumbar spine procedures and describe its treatment.

Methods: The presented study is a retrospective review of all patients who underwent lumbar decompression of the spinal canal at a tertiary institution between January 2015 and October 2019. Data collection was obtained through one independent researcher with respect to demographic data, admission charts, surgical details, and postoperative reports. In addition, preoperative magnetic resonance imaging (MRI) datasets were reviewed to evaluate potential risk factors for ID.

Results: The incidence rate of ID was 12.6% (88 of 698 cases). The most common reason for admission was disc herniation (63.2%), followed by vertebral stenosis (22.1%). ID was significantly associated with 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, multilevel surgery as well as preoperative MRI findings were not significantly correlated with the incidence of ID. Dural tears were closed with TachoSil^® (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 (55.2%). By usage of these treatment methods no patient needed reoperation.

Conclusion: In lumbar spine procedures, vertebrostenosis and its treatment, are identified as risk factors for ID. In our cohort, dural closure procedure followed by bed rest, led to complication free postoperative courses. Nevertheless, ID should not be underestimated as it leads to prolonged operating times and postoperative hospitalization.