Skip to main content

Advertisement

SpringerLink
Log in

Incidence and management of dural tears in full-endoscopic unilateral laminotomies for bilateral lumbar decompression

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To report incidence of dural lacerations in lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) and to describe patient outcomes following a novel full-endoscopic bimanual durotomy repair.

Methods

Retrospective review of prospectively collected database including 5.5 years of single surgeon experience with LE-ULBD. Patients with no durotomy were compared with patients who experienced intraoperative durotomy, including demographics, ASA score, prior surgery, number of levels treated, procedure time, hospital length of stay (LOS), visual analogue scale, perioperative complications, revision surgeries, use of analgesics, and Oswestry Disability Index (ODI).

Results

In total, 13/174 patients (7.5%) undergoing LE-ULBD experienced intraoperative durotomy. No significant differences in demographic, clinical or operative variables were identified between the 2 groups. Sustaining a durotomy increased LOS (p = 0.0019); no differences in perioperative complications or rate of revision surgery were identified. There was no difference in minimally clinically important difference for ODI between groups (65.6% for no durotomy versus 55.6% for durotomy, p = 0.54).

Conclusion

In this cohort, sustaining a durotomy increased LOS but, with accompanying intraoperative repair, did not significantly affect rate of complications, revision surgery or functional outcomes. Our method of bimanual endoscopic dural repair provides an effective approach for repair of dural lacerations in interlaminar ULBD cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this manuscript.

Abbreviations

ASA:

American Society of Anesthesiologists

CSF:

Cerebrospinal fluid

LE-ULBD:

Lumbar endoscopic unilateral laminotomy for bilateral decompression

LOS:

Hospital length of stay

MCID:

Minimal clinically important difference

MIS:

Minimally invasive surgery

ODI:

Oswestry disability index

VAS:

Visual analogue scale

References

  1. Komp M, Hahn P, Oezdemir S et al (2015) Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Phys 18:61–70

    Article  Google Scholar 

  2. Ruetten S, Komp M, Merk H, Godolias G (2009) Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine 10:476–485. https://doi.org/10.3171/2008.7.17634

    Article  PubMed  Google Scholar 

  3. McGrath LB, White-Dzuro GA, Hofstetter CP (2019) Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression. J Neurosurg Spine 30:491–499. https://doi.org/10.3171/2018.9.SPINE18689

    Article  Google Scholar 

  4. Telfeian AE, Shen J, Ali R, Oyelese A, Fridley J, Gokaslan ZL (2020) Incidence and implications of incidental durotomy in transforaminal endoscopic spine surgery: case series. World Neurosurg 134:e951–e955. https://doi.org/10.1016/j.wneu.2019.11.045

    Article  PubMed  Google Scholar 

  5. Kim HS, Raorane HD, Wu PH, Heo DW, Sharma SB, Jang I-T (2020) Incidental durotomy during endoscopic stenosis lumbar decompression: incidence, classification, and proposed management strategies. World Neurosurg 139:e13–e22. https://doi.org/10.1016/j.wneu.2020.01.242

    Article  PubMed  Google Scholar 

  6. Ghobrial GM, Theofanis T, Darden BV, Arnold P, Fehlings MG, Harrop JS (2015) Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature. Neurosurg Focus 39:E8. https://doi.org/10.3171/2015.7.FOCUS15266

    Article  PubMed  Google Scholar 

  7. 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. https://doi.org/10.1097/00007632-200010150-00019

    Article  PubMed  Google Scholar 

  8. Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80:1728–1732. https://doi.org/10.2106/00004623-199812000-00002

    Article  CAS  PubMed  Google Scholar 

  9. Tsutsumimoto T, Yui M, Uehara M, Ohta H, Kosaku H, Misawa H (2014) A prospective study of the incidence and outcomes of incidental dural tears in microendoscopic lumbar decompressive surgery. Bone Joint J 96-B:641–645. https://doi.org/10.1302/0301-620X.96B5.32957

    Article  CAS  PubMed  Google Scholar 

  10. Soma K, Kato S, Oka H et al (2019) Influence of incidental dural tears and their primary microendoscopic repairs on surgical outcomes in patients undergoing microendoscopic lumbar surgery. Spine J 19:1559–1565. https://doi.org/10.1016/j.spinee.2019.04.015

    Article  PubMed  Google Scholar 

  11. Sen RD, White-Dzuro G, Ruzevick J et al (2018) Intra- and perioperative complications associated with endoscopic spine surgery: a multi-institutional study. World Neurosurg 120:e1054–e1060. https://doi.org/10.1016/j.wneu.2018.09.009

    Article  PubMed  Google Scholar 

  12. Matsumoto M, Hasegawa T, Ito M et al (2010) Incidence of complications associated with spinal endoscopic surgery: nationwide survey in 2007 by the Committee on Spinal Endoscopic Surgical Skill Qualification of Japanese Orthopaedic Association. J Orthop Sci 15:92–96. https://doi.org/10.1007/s00776-009-1428-6

    Article  PubMed  Google Scholar 

  13. Ahn Y, Lee HY, Lee S-H, Lee JH (2011) Dural tears in percutaneous endoscopic lumbar discectomy. Eur Spine J 20:58–64. https://doi.org/10.1007/s00586-010-1493-8

    Article  PubMed  Google Scholar 

  14. Hofstetter CP, Ahn Y, Choi G et al (2020) AOSpine consensus paper on nomenclature for working-channel endoscopic spinal procedures. Glob Spine J 10:111S-121S. https://doi.org/10.1177/2192568219887364

    Article  Google Scholar 

  15. Schizas C, Theumann N, Burn A et al (2010) Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976) 35:1919–1924. https://doi.org/10.1097/BRS.0b013e3181d359bd

    Article  PubMed  Google Scholar 

  16. Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, medical outcomes study questionnaire short form 36, and pain scales. Spine J 8:968–974. https://doi.org/10.1016/j.spinee.2007.11.006

    Article  PubMed  Google Scholar 

  17. Hasan S, Härtl R, Hofstetter CP (2019) The benefit zone of full-endoscopic spine surgery. J Spine Surg 5:S41–S56. https://doi.org/10.21037/jss.2019.04.19

    Article  PubMed  PubMed Central  Google Scholar 

  18. Schroeder GD, Kepler CK, Alijanipour P et al (2016) The economic implications of an incidental durotomy. Spine (Phila Pa 1976) 41:1548–1553. https://doi.org/10.1097/BRS.0000000000001583

    Article  PubMed  Google Scholar 

  19. Oertel JM, Burkhardt BW (2017) Full endoscopic treatment of dural tears in lumbar spine surgery. Eur Spine J 26:2496–2503. https://doi.org/10.1007/s00586-017-5105-8

    Article  PubMed  Google Scholar 

  20. Heo DH, Ha JS, Lee DC, Kim HS, Chung HJ (2022) Repair of incidental Durotomy using sutureless nonpenetrating clips via biportal endoscopic surgery. Global Spine J 12:452–457. https://doi.org/10.1177/2192568220956606

    Article  PubMed  Google Scholar 

  21. Park H-J, Kim S-K, Lee S-C, Kim W, Han S, Kang S-S (2020) Dural tears in percutaneous biportal endoscopic spine surgery: anatomical location and management. World Neurosurg 136:e578–e585. https://doi.org/10.1016/j.wneu.2020.01.080

    Article  PubMed  Google Scholar 

  22. Shin JK, Youn MS, Seong YJ, Goh TS, Lee JS (2018) Iatrogenic dural tear in endoscopic lumbar spinal surgery: full endoscopic dural suture repair (Youn’s technique). Eur Spine J 27:544–548. https://doi.org/10.1007/s00586-018-5637-6

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the Endoscopic Spine Research Group (ESRG, https://www.myhealthie.com/) for many informative discussions.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA

    Madeline E. Greil, Sharon Durfy & Christoph P. Hofstetter

  2. Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA

    Julia Bergquist

  3. Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA

    Osama N. Kashlan

  4. Department of Neurosurgery, College of Medicine, Korea University Guro Hospital, Korea University, Seoul, Republic of Korea

    Woo-Keun Kwon

Authors
  1. Madeline E. Greil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julia Bergquist
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osama N. Kashlan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Woo-Keun Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sharon Durfy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph P. Hofstetter
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CPH contributed to Conceptualization and Design; JB contributed to Acquisition of Data; MEG, ONK, CPH contributed to Analysis and Interpretation of Data; MEG, ONK contributed to Drafting the Article; MEG, ONK, SD, CPH contributed to Critically Revising Article; all authors contributed to Review Submitted Version of Manuscript; ONK contributed to Statistical Analysis; ONK, CPH contributed to Study Supervision.

Corresponding author

Correspondence to Christoph P. Hofstetter.

Ethics declarations

Conflict of interest

Dr. Hofstetter is a consultant for Joimax, Globus. Medical, Innovasis, and Johnson & Johnson.

Ethics approval

The University of Washington Human Subjects Division reviewed and approved this retrospective research study (IRB07742) with a waiver of informed consent, appropriately compliant with institutional requirements, and conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 184492 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Greil, M.E., Bergquist, J., Kashlan, O.N. et al. Incidence and management of dural tears in full-endoscopic unilateral laminotomies for bilateral lumbar decompression. Eur Spine J 32, 2889–2895 (2023). https://doi.org/10.1007/s00586-023-07749-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07749-7

Keywords

Search

Navigation