PHILADELPHIA — Incidental durotomy, the accidental breach of the dural covering of the spinal cord and nerve roots, occurring during lumbar discectomy, does not appear to have any effect on long-term outcomes of the procedure, according to data taken from the Spine Patients Outcomes Research Trial — better known as SPORT.
“Lumbar discectomy is one of the most common surgical procedures performed in the United States, and incidental durotomy is one of the most frequent complications of the surgery,” said Atman Desai, MD, at the 78th Annual Meeting of the American Association of Neurological Surgeons, here.
Despite that, he said there are little data published on whether these complications affect long-term patient outcomes.
Desai and colleagues at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., used data collected for SPORT on 2,500 patients treated at 13 centers in 11 states. Data were gathered at baseline, 3, 6, 12 and 24 months. From the database, 25 patients with long-term outcomes were found to have had an incidental durotomy during a first-time lumbar discectomy — a 3.2% incidence. The mean follow-up of this group was 41.5 months, he said.
The investigators used SF-36 questionnaires for bodily pain, physical function and mental component summary scores, Oswestry Disability Index scores and Sciatica Bothersome Index scores to assess patient outcomes, and scores were calculated at each follow-up interval. They used the data to compare the outcomes of the patients with an incidental durotomy, with a cohort of 759 similar patients who also underwent an initial lumbar discectomy. The two groups were also similar in the precise type and site of lumbar disc herniation.
The investigators found that the patients who had an incidental durotomy during surgery had significantly longer surgeries, more operative blood loss and greater length of hospital stay.
“Despite the increased blood loss, there were no differences in incidence of nerve root injury, postoperative mortality, infection or the need for additional surgeries or at 1, 2, 3 and 4 years,” Desai said.
He also said there were no major differences in any of the outcomes scores studied.
“This study indicates that although the occurrence of an incidental durotomy during lumbar discectomy seems to increase operative duration, blood loss, and length of stay in hospital, it does not appear to affect long-term outcome in affected patients,” Desai reported.
Desai A, Ball PA, Lurie J, et al. Outcomes after incidental durotomy during lumbar discectomy. Presented at the 78th Annual Meeting of the American Association of Neurological Surgeons. May 1-5, 2010. Philadelphia.
There have been several retrospective studies that have concluded that incidental durotomy does not affect long term patient outcomes. It is re-assuring to know that a well-designed prospective cohort that was part of the SPORT study also showed the same result.
- Scott D. Boden, MD
Orthopedics Today Editorial Board
Spine Section Editor