The frequency and etiology of intraoperative dural tears in 110 predominantly geriatric patients undergoing multilevel laminectomy with noninstrumented fusions

Abstract

Study design: A retrospective analysis of the frequency and etiology of dural tears (DT), defined as an unintended incidental intraoperative durotomy, occurring in 110 predominantly geriatric patients undergoing multilevel laminectomies with noninstrumented fusions.

Objective: To document the frequency and etiology of DT occurring in these older patients.

Summary of background data: The frequency and etiology of DT occurring in older patients are not well documented.

Methods: The clinical (including comorbidities), neurodiagnostic, surgical procedures, and Short-Form 36 outcomes (questionnaires administered preoperatively, and 3, 6, 12 mo postoperatively) were retrospectively analyzed for these 110 patients with/without DT.

Results: Intraoperative DT occurred in 10 of 110 patients. These patients were typically older (average 74 y with fistulas vs. 69 y old without fistulas), included a higher percentage of females (90% vs. 76%), and had undergone somewhat more extensive laminectomies (5.5 vs. 5.0 levels) with noninstrumented fusions (1.8 vs. 1.6 levels). Three factors seemed to contribute to DT. Marked ossification of the yellow ligament (OYL), documented in all 10 patients with DT, extended to and through the dura in 3 patients. For the 100 patients without DT, 57 exhibited moderate/hypertrophied yellow ligament and 22 showed marked OYL. Synovial cysts with marked OYL were observed in 5 of 10 patients with DT, whereas only 8 of 100 without DT had synovial cysts. Prior surgical scar, originally anticipated to be a major contributing factor to DT, was found in only 2 of 10 patients with DT (also with marked OYL) compared with 10% without DT. Short-Form 36 outcome data revealed improvement on 4 or 5 Health Scales over the first postoperative year for both populations.

Conclusions: Ten of 110 patients undergoing multilevel laminectomies and noninstrumented fusions developed unintended incidental DT attributed to OYL extending to/through the dura (3 patients), postoperative scar/marked OYL (2 patients), and synovial cysts/marked OYL (5 patients).