The long-term clinical sequelae of incidental durotomy in lumbar disc surgery

Abstract

Study design: A retrospective, long-term follow-up study.

Objectives: To find out whether incidental durotomy in lumbar disc surgery is associated with long-term sequelae.

Summary of background data: Incidental durotomy is a frequent complication during spinal surgery. Little is known about the clinical long-term outcome.

Methods: The study population comprised 1,280 patients who underwent standard discectomy of a lumbar disc herniation. A total of 41 patients with incidental durotomies (Group A) were compared with a control group (n = 41) (Group B) matched for age, sex, spinal level, and duration of follow-up. After a mean follow-up period of 10.2 years (Group A) or 10.3 years (Group B), the patients reported complaints, headache, and low back or leg pain. The patients' activity was assessed by means of a questionnaire concerning hindrance in daily activities, the Tegner score for general activities in daily life, and the Hannover Functional Ability Questionnaire for Measuring Back Pain-Related Functional Limitations (FFbH-R). The frequency of reoperation and the intake of analgesics were included. Furthermore, the patients' inability to work, change of profession, and retirement were registered.

Results: Patients with incidental durotomy had a poorer outcome after surgery. The Tegner score was significantly decreased for the group with dural tears. Furthermore, significant more patients with incidental durotomy complained about headaches after surgery. A strong tendency for worse outcome in Group A was shown in regard to reported complaints and daily activity. The patients with incidental durotomy had a tendency to more reoperations, a longer duration of inability to work, more back-pain, and functional limitations related to back-pain (FFbH-R).

Conclusion: Our study revealed that incidental durotomy in lumbar disc surgery was associated with long-term clinical sequelae. We therefore conclude that dural tears bring about poor clinical outcome at the long-term follow-up.