Dural Tear, a Feared Complication of Spine Surgery

OBJECTIVES To investigate the incidence, risk factors and clinical presentation of complications in patients undergoing spinal surgery with and without Dural Tear. METHODOLOGY A one-year prospective case-control study was conducted in the department of orthopaedics and spinal surgery at the Hayatabad Medical Complex (HMC) and Rahman Medical and surgical centre Dagger Buner. The spine surgeon used a discrete surgical approach. The questionnaire was used to collect patient demographic data, surgical information, and data on perioperative and postoperative complications. SPSS version 21.0 statistical software was used for all statistical analyses. RESULTS Dural tears were observed in 3.4% of the patients, among whom 20% experienced a Dural leak. After controlling for potentially confounding variables of age, sex, primary disease, and type of procedure, the surgery-related complications that were more likely to occur in the Dural Tear group than in the non-TD group were surgical site complications OR 2.69 and postoperative neurological defect O 3.28. The proportion of postoperative delirium OR 3.22 was significantly high in the Dural Tear group as perioperative complications CONCLUSION A higher proportion of surgical site infections, postoperative neurological defects and delirium in the Dural Tear group are due to direct complications, such as Dural leakage.

[1]  A. Mannion,et al.  Incidental durotomy in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcomes in the Spine Tango registry , 2017, European Spine Journal.

[2]  H. Nakajima,et al.  Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study , 2017, Global spine journal.

[3]  A. Aichmair,et al.  Incidental Durotomy During Spinal Surgery: A Multivariate Analysis for Risk Factors , 2014, Spine.

[4]  Timothy R. Darlington,et al.  No difference in postoperative complications, pain, and functional outcomes up to 2 years after incidental durotomy in lumbar spinal fusion: a prospective, multi-institutional, propensity-matched analysis of 1,741 patients. , 2014, The spine journal : official journal of the North American Spine Society.

[5]  C. Fisher,et al.  Prospective analysis of adverse events in surgical treatment of degenerative spondylolisthesis. , 2012, The spine journal : official journal of the North American Spine Society.

[6]  Daisuke Yoneoka,et al.  Incidental dural tear in spine surgery: analysis of a nationwide database , 2014, European Spine Journal.

[7]  J. Chapman,et al.  Risk factors for unintended durotomy during spine surgery: a multivariate analysis. , 2012, The spine journal : official journal of the North American Spine Society.

[8]  B. Strömqvist,et al.  Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome , 2012, European Spine Journal.

[9]  B. Darden,et al.  Dural Tears in Spine Surgery , 2010, The Journal of the American Academy of Orthopaedic Surgeons.

[10]  James D. Kang,et al.  Postoperative Management Protocol for Incidental Dural Tears During Degenerative Lumbar Spine Surgery: A Review of 3,183 Consecutive Degenerative Lumbar Cases , 2006, Spine.

[11]  Y. Kawaguchi,et al.  Postoperative delirium in spine surgery. , 2006, The spine journal : official journal of the North American Spine Society.

[12]  O. Karaeminoğullari,et al.  Dural Tears in Lumbar Burst Fractures With Greenstick Lamina Fractures , 2001, Spine.

[13]  M. Gardner,et al.  Evaluation and treatment of dural tears in lumbar spine surgery: a review. , 2001, Clinical orthopaedics and related research.

[14]  F. Cammisa,et al.  Incidental Durotomy in Spine Surgery , 2000, Spine.

[15]  Roberto Contro,et al.  Lumbar dura mater biomechanics: experimental characterization and scanning electron microscopy observations. , 1999, Anesthesia and analgesia.

[16]  L. Wiart,et al.  [Medical treatment of spinal cord injury in the acute stage]. , 1998, Annales francaises d'anesthesie et de reanimation.

[17]  I. Lambrichts,et al.  Ultrastructure of the human spinal arachnoid mater and dura mater. , 1996, Journal of anatomy.

[18]  B. Green,et al.  Dural laceration occurring with burst fractures and associated laminar fractures. , 1989, The Journal of bone and joint surgery. American volume.

[19]  V. Seifert,et al.  Intra- and Postoperative Complications in Lumbar Disc Surgery , 1989, Spine.

[20]  R. Rothman,et al.  Treatment of dural tears associated with spinal surgery. , 1981, The Journal of bone and joint surgery. American volume.