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Incidental durotomy in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcomes in the Spine Tango registry

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Abstract

Purpose

The three aims of this Spine Tango registry study of patients undergoing decompression for spinal stenosis were to: report the rate of dural tear (DT) stratified by treatment centre; find factors associated with an increased likelihood of incurring a DT; and compare treatment outcomes in relation to DT (none vs. repaired vs. unrepaired DT).

Methods

Multivariate logistic regression was used to assess the association between DT and patient and treatment characteristics. Patient-rated and surgical outcomes were compared in patients with no DT, repaired DT, and unrepaired DT, while adjusting for case-mix.

Results

DT occurred in 328/3254 (10.1%) of included patients. The rate for all 29 contributing hospitals was within 95% confidence intervals of the average. The likelihood of DT increased by 2% per year of age, 1.78 times with previous spine surgery, 1.67 for a minimally/less invasive surgery, 1.58 times with laminectomy, and 1.40, and 2.12 times for BMI 31–35, and >35 in comparison with BMI 26–30, respectively. The majority of DTs (272/328; 82.9%) were repaired. Repairing the DT was associated with a longer duration of surgery (p < 0.001). More patients with repaired than with unrepaired DTs were satisfied with treatment, but the difference was not statistically significant. There was no association between DT and patient-reported outcomes.

Conclusion

The unadjusted rate of incidental DT during decompression for LSS was homogeneous across the participating centres and was associated with age, BMI, previous surgery at the same spinal level, minimally/less invasive surgery, and laminectomy. Non-repair of DTs had no negative association with treatment outcome; however, the unrepaired DTs may have been those that were smaller in size.

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References

  1. Sobottke R, Herren C, Siewe J, Mannion AF, Roder C, Aghayev E (2017) Predictors of improvement in quality of life and pain relief in lumbar spinal stenosis relative to patient age: a study based on the Spine Tango registry. Eur Spine J 26:462–472. doi:10.1007/s00586-015-4078-8

    Article  PubMed  Google Scholar 

  2. Kalevski SK, Peev NA, Haritonov DG (2010) Incidental dural tears in lumbar decompressive surgery: incidence, causes, treatment, results. Asian J Neurosurg 5:54–59

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Tafazal SI, Sell PJ (2005) Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J 14:287–290. doi:10.1007/s00586-004-0821-2

    Article  PubMed  Google Scholar 

  4. Saxler G, Kramer J, Barden B, Kurt A, Pfortner J, Bernsmann K (2005) The long-term clinical sequelae of incidental durotomy in lumbar disc surgery. Spine (Phila Pa 1976) 30:2298–2302

    Article  Google Scholar 

  5. Munting E, Roder C, Sobottke R, Dietrich D, Aghayev E, Spine Tango C (2015) Patient outcomes after laminotomy, hemilaminectomy, laminectomy and laminectomy with instrumented fusion for spinal canal stenosis: a propensity score-based study from the Spine Tango registry. Eur Spine J 24:358–368. doi:10.1007/s00586-014-3349-0

    Article  PubMed  Google Scholar 

  6. Desai A, Ball PA, Bekelis K, Lurie J, Mirza SK, Tosteson TD, Weinstein JN (2015) SPORT: does incidental durotomy affect longterm outcomes in cases of spinal stenosis? Neurosurgery 76(Suppl 1):S57–S63. doi:10.1227/01.neu.0000462078.58454.f4

    Article  PubMed  PubMed Central  Google Scholar 

  7. Stromqvist F, Jonsson B, Stromqvist B (2012) Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome. Eur Spine J 21:825–828. doi:10.1007/s00586-011-2101-2

    Article  PubMed  Google Scholar 

  8. Baker GA, Cizik AM, Bransford RJ, Bellabarba C, Konodi MA, Chapman JR, Lee MJ (2012) Risk factors for unintended durotomy during spine surgery: a multivariate analysis. Spine J 12:121–126. doi:10.1016/j.spinee.2012.01.012

    Article  PubMed  PubMed Central  Google Scholar 

  9. Burks CA, Werner BC, Yang S, Shimer AL (2015) Obesity is associated with an increased rate of incidental durotomy in lumbar spine surgery. Spine (Phila Pa 1976) 40:500–504. doi:10.1097/brs.0000000000000784

    Article  Google Scholar 

  10. Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA (1992) Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Jt Surg Am 74:536–543

    Article  CAS  Google Scholar 

  11. Shaffrey CI, Spotnitz WD, Shaffrey ME, Jane JA (1990) Neurosurgical applications of fibrin glue: augmentation of dural closure in 134 patients. Neurosurgery 26:207–210

    Article  CAS  PubMed  Google Scholar 

  12. Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P, Cheng BC, Faught R, Welch WC (2009) Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J 18:1169–1174. doi:10.1007/s00586-009-0928-6

    Article  PubMed  PubMed Central  Google Scholar 

  13. Khan MH, Rihn J, Steele G, Davis R, Donaldson WF 3rd, Kang JD, Lee JY (2006) Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976) 31:2609–2613. doi:10.1097/01.brs.0000241066.55849.41

    Article  Google Scholar 

  14. Espiritu MT, Rhyne A, Darden BV 2nd (2010) Dural tears in spine surgery. J Am Acad Orthop Surg 18:537–545

    Article  PubMed  Google Scholar 

  15. Song Y, Li S, Song B, Zhang Y, Gao W, Li N, Fan K, Ma J (2014) The pathological changes in the spinal cord after dural tear with and without autologous fascia repair. Eur Spine J 23:1531–1540. doi:10.1007/s00586-014-3326-7

    Article  PubMed  Google Scholar 

  16. Epstein NE (2007) The frequency and etiology of intraoperative dural tears in 110 predominantly geriatric patients undergoing multilevel laminectomy with noninstrumented fusions. J Spinal Disord Tech 20:380–386. doi:10.1097/BSD.0b013e31802dabd2

    Article  PubMed  Google Scholar 

  17. Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS (2000) Incidental durotomy in spine surgery. Spine (Phila Pa 1976) 25:2663–2667

    Article  Google Scholar 

  18. Sporns PB, Zimmer S, Hanning U, Zoubi T, Wolfer J, Herbort M, Schwindt W, Niederstadt T (2015) Acute tonsillar cerebellar herniation in a patient with traumatic dural tear and VAC therapy after complex trauma. Spine J 15:e13–e16. doi:10.1016/j.spinee.2015.04.025

    Article  PubMed  Google Scholar 

  19. Desai A, Ball PA, Bekelis K, Lurie J, Mirza SK, Tosteson TD, Weinstein JN (2011) SPORT: does incidental durotomy affect long-term outcomes in cases of spinal stenosis? Neurosurgery 69:38–44. doi:10.1227/NEU.0b013e3182134171

    Article  PubMed  PubMed Central  Google Scholar 

  20. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ 85:867–872

    Article  Google Scholar 

  21. Melloh M, Staub L, Aghayev E, Zweig T, Barz T, Theis JC, Chavanne A, Grob D, Aebi M, Roeder C (2008) The international spine registry SPINE TANGO: status quo and first results. Eur Spine J 17:1201–1209. doi:10.1007/s00586-008-0665-2

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective. Part 1: The Core Outcome Measures Index in clinical practice. Eur Spine J 18(Suppl 3):367–373. doi:10.1007/s00586-009-0942-8

    Article  PubMed  PubMed Central  Google Scholar 

  23. Staub LP, Ryser C, Roder C, Mannion AF, Jarvik JG, Aebi M, Aghayev E (2016) Total disc arthroplasty versus anterior cervical interbody fusion: use of the Spine Tango registry to supplement the evidence from randomized control trials. Spine J 16:136–145. doi:10.1016/j.spinee.2015.11.056

    Article  PubMed  Google Scholar 

  24. Williams BJ, Sansur CA, Smith JS, Berven SH, Broadstone PA, Choma TJ, Goytan MJ, Noordeen HH, Knapp DR Jr, Hart RA, Zeller RD, Donaldson WF 3rd, Polly DW Jr, Perra JH, Boachie-Adjei O, Shaffrey CI (2011) Incidence of unintended durotomy in spine surgery based on 108,478 cases. Neurosurgery 68:117–124. doi:10.1227/NEU.0b013e3181fcf14e

    Article  PubMed  Google Scholar 

  25. Adam D, Papacocea T, Iliescu R (2015) Incidental durotomy in lumbar spine surgery—incidence, risk factors and management. Romanian Neurosurg 22:20–26

    Article  Google Scholar 

  26. Sin AH, Caldito G, Smith D, Rashidi M, Willis B, Nanda A (2006) Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery. J Neurosurg Spine 5:224–227. doi:10.3171/spi.2006.5.3.224

    Article  PubMed  Google Scholar 

  27. Teli M, Lovi A, Brayda-Bruno M, Zagra A, Corriero A, Giudici F, Minoia L (2010) Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J 19:443–450. doi:10.1007/s00586-010-1290-4

    Article  PubMed  PubMed Central  Google Scholar 

  28. Du JY, Aichmair A, Kueper J, Lam C, Nguyen JT, Cammisa FP, Lebl DR (2014) Incidental durotomy during spinal surgery: a multivariate analysis for risk factors. Spine (Phila Pa 1976) 39:E1339–1345. doi:10.1097/BRS.0000000000000559

    Article  Google Scholar 

  29. Grannum S, Patel MS, Attar F, Newey M (2014) Dural tears in primary decompressive lumbar surgery. Is primary repair necessary for a good outcome? Eur Spine J 23:904–908. doi:10.1007/s00586-013-3159-9

    Article  PubMed  PubMed Central  Google Scholar 

  30. Nandyala SV, Elboghdady IM, Marquez-Lara A, Noureldin MN, Sankaranarayanan S, Singh K (2014) Cost analysis of incidental durotomy in spine surgery. Spine (Phila Pa 1976) 39:E1042–1051. doi:10.1097/brs.0000000000000425

    Article  Google Scholar 

  31. Kothe R, Quante M, Engler N, Heider F, Kneissl J, Pirchner S, Siepe C (2016) The effect of incidental dural lesions on outcome after decompression surgery for lumbar spinal stenosis: results of a multi-center study with 800 patients. Eur Spine J. doi:10.1007/s00586-016-4571-8

    Google Scholar 

  32. Ulrich NH, Burgstaller JM, Brunner F, Porchet F, Farshad M, Pichierri G, Steurer J, Held U (2016) The impact of incidental durotomy on the outcome of decompression surgery in degenerative lumbar spinal canal stenosis: analysis of the Lumbar Spinal Outcome Study (LSOS) data—a Swiss prospective multi-center cohort study. BMC Musculoskelet Disord 17:170. doi:10.1186/s12891-016-1022-y

    Article  PubMed  PubMed Central  Google Scholar 

  33. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424. doi:10.1080/00273171.2011.568786

    Article  Google Scholar 

  34. Mannion AF, Fekete TF, O’Riordan D, Porchet F, Mutter UM, Jeszenszky D, Lattig F, Grob D, Kleinstueck FS (2013) The assessment of complications after spine surgery: time for a paradigm shift? Spine J 13:615–624. doi:10.1016/j.spinee.2013.01.047

    Article  PubMed  Google Scholar 

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Acknowledgements

All the participants of the Spine Tango Register are acknowledged for their continuous contribution that makes it possible for us to conduct such studies reflecting the daily practice of spine surgeons. The data of the following centres were used (in alphabetic order of country, city, hospital and department): Department of Spinal Surgery in Royal Adelaide Hospital (Australia); Department of Spinal Surgery in St. Andrew’s Hospital in Adelaide (Australia); Department of Orthopaedic Surgery in Grand Hôpital de Charleroi (Belgium); Department of Orthopaedic Surgery in Edith Cavell Clinic of Brussels (Belgium); Department of Orthopaedic Surgery in University Hospital of St. Luc (Belgium); Department of Orthopaedic Surgery in Saint Pierre Clinic of Ottignies (Belgium); Department of Neurosurgery in University Hospital of Cologne (Germany); Department of Orthopaedic Surgery and Traumatology in University Hospital of Cologne (Germany); Group Practice of Orthopaedics and Neurosurgery in Hof (Germany); Department of Spine Surgery in Krankenhaus der Barmherzigen Brüder in Trier (Germany); Department of Orthopedic Surgery in Orthopedic and Traumatological Clinic Poznan (Poland); Department of Neurosurgery in Specialized Medical Center S.A. Polanica (Poland); Department of Neurosurgery in Medical University Silesia (Poland); Department of Neurosurgery in Hospital São João in Porto (Portugal); Department of Neurosurgery in Bethesda Hospital of Basel (Switzerland); Department of Neurosurgery in University Hospital of Bern (Switzerland); Department of Spine Surgery in University Hospital of Bern (Switzerland); Department of Orthopaedic Surgery in Salem Hospital of Bern (Switzerland); Department of Orthopaedic Surgery in Cantonal Hospital of Fribourg (Switzerland); Department of Neurosurgery in Clinique Générale of Fribourg (Switzerland); Department of Neurosurgery and Spine Surgery in St. Anna Clinic in Lucerne (Switzerland); Department of Orthopaedic Surgery and Traumatology in Cantonal Hospital of St. Gallen (Switzerland); Department of Spine Surgery in The Spine Center Thun (Switzerland); Spine Center Division in Schulthess Clinic of Zurich (Switzerland); Spine Unit of Nuffield Oxford Centre (UK); Department of Neurosurgery in Salford Royal NHS Foundation Trust (UK); Department of Spine Surgery in Salford Royal NHS Foundation Trust (UK); Department of Neurosurgery in The Walton Centre (UK); Department of Spine Surgery of Christiana Care Hospital in Newark, Delaware (USA).

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    Authors and Affiliations

    1. Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

      Christian Herren

    2. Department of Orthopaedic and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Straße 9, 50924, Cologne, Germany

      Rolf Sobottke & Jan Siewe

    3. Department of Orthopaedic Surgery, Medizinisches Zentrum StädteRegion Aachen, Mauerfeldchen 25, 52146, Würselen, Germany

      Rolf Sobottke

    4. Spine Centre Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

      Anne F. Mannion & Emin Aghayev

    5. Spinecenter, Schänzlistrasse 39, 3025, Bern, Switzerland

      Thomas Zweig

    6. Institute for Social and Preventive Medicine, Finkenhubelweg 11, 3012, Bern, Switzerland

      Thomas Zweig

    7. Clinique Saint Pierre, Av. Reine Fabiola 9, 1340 Ottignies, Belgium

      Everard Munting

    8. Clinique Générale de Fribourg, Rue Hans-Geiler 6, 1700, Fribourg, Switzerland

      Philippe Otten

    9. Department of Neurosurgery, Walton Centre for Neurosurgery, Lower Lane, L9 7LJ, Liverpool, UK

      Tim Pigott

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    Correspondence to Christian Herren.

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    Herren, C., Sobottke, R., Mannion, A.F. et al. Incidental durotomy in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcomes in the Spine Tango registry. Eur Spine J 26, 2483–2495 (2017). https://doi.org/10.1007/s00586-017-5197-1

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