Abstract
BackgroundIncidental durotomy is a well-known complication during surgery for degenerative lumbar spinal stenosis (DLSS). In this prospective multicenter cohort study including eight medical centers our aim was to assess whether incidental durotomy during first-time lumbar spinal stenosis decompression surgery without fusion has an impact on long-term outcome.MethodsPatients of the multi-center Lumbar Stenosis Outcome Study (LSOS) with confirmed DLSS undergoing first-time decompression without fusion were enrolled in this study. Baseline patient characteristics and outcomes were analyzed at 6, 12, and 24 months follow-up respectively with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ).ResultsA total of 167 patients met the inclusion criteria. Fifteen (9 %) of those patients had an incidental durotomy. Baseline characteristics were similar between the durotomy and no-durotomy group. All patients improved over time. In the group of durotomy patients, the median improvement in SSM symptoms scale was 1.1 points at 6 months, 1.1 points at 12 months, and 1.6 points at 24 months after baseline. For the no-durotomy group, these improvements were 0.8, 0.9, and 0.9. For SSM function the improvements were 1.0, 0.8, and 0.9 in the durotomy group, and 0.6, 0.8, and 0.8 in the no-durotomy group. None of the between-group differences were statistically significant.ConclusionsIncidental durotomy in patients with DLSS undergoing first-time decompression surgery without fusion did not have negative effect on long-term outcome and quality of life. However, only 15 patients were included in the durotomy group but these findings remained even after adjusting for observed differences in baseline characteristics.
Highlights
Incidental durotomy is a well-known complication during surgery for degenerative lumbar spinal stenosis (DLSS)
The purpose of this study was to assess whether incidental durotomy during first-time decompression surgery without fusion for degenerative lumbar spinal stenosis had an impact on long-term outcomes
In this study we investigated 167 consecutive patients with symptomatic degenerative lumbar spinal canal stenosis undergoing lumbar decompression surgery without fusion
Summary
Incidental durotomy is a well-known complication during surgery for degenerative lumbar spinal stenosis (DLSS). Persistent dural tears may cause various sequelae such as headache, meningeal pseudocyst formation, or dural cutaneous cerebrospinal fluid fistulas leading to meningitis and arachnoiditis [3, 12]. Recommendations to prevent these sequelae are primary repair, bed rest, and lumbar drain placement [3, 9, 14]. Long-term effects for decompression surgery only without fusion for degenerative lumbar spinal stenosis (DLSS) have not been studied so far. In the metropolitan area of Zurich with around 1.3 million inhabitants almost 1000 lumbar decompression surgeries without fusions in patients with DLSS are performed every year [19]
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