Clinical Outcome of Spine Surgery Complicated by Accidental Dural Tears: Meta-Analysis of the Literature

Alshameeri, Zeiad; Ahmed, El-Nasri; Jasani, Vinay

doi:10.1177/2192568220914876

Cited by 9 publications

(13 citation statements)

References 23 publications

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“…A systematic literature search was conducted as part of a comprehensive project looking at the treatment and outcome of DTs in elective spinal surgery. 9,10 The method of the systematic literature search and MeSH terms used were reported in previous publications. 9,10 Briefly, this was conducted in Embase, Cochrane, Medline, and PubMed from inception until the end of January 2019.…”

Section: Methodsmentioning

confidence: 99%

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Risk Factors for Accidental Dural Tears in Spinal Surgery

Alshameeri

Jasani

2021

Int J Spine Surg

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Background: Accidental dural tears (DTs) are familiar complications of spinal surgery. Their reported incidence varies widely, and several risk factors have been proposed in the literature. The aim of this study was to conduct a systematic review and meta-analysis to determine the rate of DTs and assess their associated risk factors.Methods: A systematic literature search was conducted using specific MeSH and Text terms. Only articles with prospective data reporting the incidence and risk factors were selected and reviewed based on specific inclusion and exclusion criteria.Results: Twenty-three studies were included. The reported incidence rate ranged from 0.4% to 15.8%, giving an overall pooled incidence rate of 5.8% (95% confidence interval [CI] 4.4À7.3). The incidence rate varied in relation to the part of the spine and the type of surgery. Three factors were associated with a high rate of DTs: age (overall mean difference of 3.04, 95% CI 2.49À3.60), revision surgery (overall odds ratio of 2.28, 95% CI 1.84À2.83), and lumbar stenosis (overall odds ratio of 2.03, 95% CI 1.50À2.75). Diabetes was weakly associated with DTs, with an odds ratio of 1.40 (95% CI 1.01À1.93). The overall effects of sex and obesity were not statistically significant.Conclusion: Advancing age, revision surgery, and lumbar stenosis were significantly associated with increased risk of DTs. These factors should be taken into consideration during the consenting process for spinal surgery.Clinical Relevance: Risk of dural tear during spine surgery.

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Section: Methodsmentioning

confidence: 99%

“…9,10 The method of the systematic literature search and MeSH terms used were reported in previous publications. 9,10 Briefly, this was conducted in Embase, Cochrane, Medline, and PubMed from inception until the end of January 2019. The identification and selection process of the studies followed the PRISMA flow chart (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Accidental Dural Tears in Spinal Surgery

Alshameeri

Jasani

2021

Int J Spine Surg

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“…Most studies mention the risk of DT only in one specific type of surgery, either open surgery or MIS. Despite a review of literature comparing the different studies, no significant difference in the risk of DT was found between the two approaches [ 12 , 13 , 15 , 16 ]. We feel that the lack of a matched cohort in the current literature makes it difficult to compare the incidence of DT among different surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

“…While there are many meta-analyses and literature reviews on incidental durotomy in open surgeries, most studies on MIS have relatively small prospective or retrospective cohorts [11][12][13][14][15][16]. In the absence of matched cohort studies, it is difficult to compare the incidence of DT in open versus MIS groups.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Dural Tears in Open versus Minimally Invasive Spine Surgery: A Single-Center Prospective Study

Sharma¹,

Shakya²,

Singh³

et al. 2022

Asian Spine J

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Study Design: A prospective comparative study.Purpose: To compare the incidence of unintended durotomy and return to work after open surgery versus minimally invasive spine surgery (MIS) for degenerative lumbar pathologies.Overview of Literature: The incidence of accidental durotomy varies between 0.3% and 35%. Most of these are from open surgeries, and only a handful of studies have involved the MIS approach. No single-center studies have compared open surgery with MIS, especially in the context of early return to work and dural tear (DT).Methods: This study included 420 operated cases of degenerative lumbar pathology with a prospective follow-up of at least 6 months. Patients were divided into the open surgery and MIS groups, and the incidences of DT, early return to work, and various demographic and operative factors were compared.Results: A total of 156 and 264 patients underwent MIS and open surgery, respectively. Incidental durotomy was documented in 52 cases (12.4%); this was significantly less in the MIS group versus the open surgery group (6.4% vs. 15.9%, <i>p</i> <0.05). In the open surgery group, four patients underwent revision for persistent dural leak or pseudomeningocele, but none of the cases in the MIS group had revision surgery due to DT-related complications. The incidence of DT was higher among patients with high body mass index, patients with diabetes mellitus, and patients who underwent revision surgery (<i>p</i> <0.05) regardless of the approach. The MIS group returned to work significantly earlier.Conclusions: MIS was associated with a significantly lower incidence of DT and earlier return to work compared with open surgery among patients with degenerative lumbar pathology.

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“…However, the effect of ID on clinical outcomes is debated, and previously published data is somewhat conflicting. A systematic review found minor differences in Oswestry Disability Index (ODI) scores between patients with and without ID [ 5 ]. Interpreting differences in patient-reported outcome measures (PROMs) between groups may be challenging, and few studies have used dichotomous endpoints.…”

Section: Introductionmentioning

confidence: 99%

Incidental dural tears associated with worse clinical outcomes in patients operated for lumbar spinal stenosis

Alhaug

Dolatowski

Austevoll³

et al. 2022

Acta Neurochir

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Study design Retrospective cohort study. Objective Incidental dural (ID) tear is a common complication of spine surgery with a prevalence of 4–10%. The association between ID and clinical outcome is uncertain. Former studies found only minor differences in Oswestry Disability Index (ODI). We aimed to examine the association of ID with treatment failure after surgery for lumbar spinal stenosis (LSS). Methods Between 2007 and 2017, 11,873 LSS patients reported to the national Norwegian spine registry (NORspine), and 8,919 (75.1%) completed the 12-month follow-up. We used multivariate logistic regression to study the association between ID and failure after surgery, defined as no effect or any degrees of worsening; we also compared mean ODI between those who suffered a perioperative ID and those who did not. Results The mean (95% CI) age was 66.6 (66.4–66.9) years, and 52% were females. The mean (95% CI) preoperative ODI score (95% CI) was 39.8 (39.4–40.1); all patients were operated on with decompression, and 1125 (12.6%) had an additional fusion procedure. The prevalence of ID was 4.9% (439/8919), and the prevalence of failure was 20.6% (1829/8919). Unadjusted odds ratio (OR) (95% CI) for failure for ID was 1.51 (1.22–1.88); p < 0.001, adjusted OR (95% CI) was 1.44 (1.11–1.86); p = 0.002. Mean postoperative ODI 12 months after surgery was 27.9 for ID vs. 23.6 for no ID. Conclusion We demonstrated a significant association between ID and increased odds for patient-reported failure 12 months after surgery. However, the magnitude of the detrimental effect of ID on the clinical outcome was small.

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Clinical Outcome of Spine Surgery Complicated by Accidental Dural Tears: Meta-Analysis of the Literature

Cited by 9 publications

References 23 publications

Risk Factors for Accidental Dural Tears in Spinal Surgery

Risk Factors for Accidental Dural Tears in Spinal Surgery

Incidence of Dural Tears in Open versus Minimally Invasive Spine Surgery: A Single-Center Prospective Study

Incidental dural tears associated with worse clinical outcomes in patients operated for lumbar spinal stenosis

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