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

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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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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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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Keywords

  • Spine Tango registry
  • Lumbar spinal stenosis
  • Decompression
  • Durotomy
  • Outcome