Dural lesions in lumbar disc herniation surgery: incidence, risk factors, and outcome

Abstract

In lumbar disc herniation surgery, dural lesions seem to be the most common complication today. Studies on incidence of and outcome after a dural lesion are mainly based on retrospective studies. In a prospective study within the framework of the Swedish Spine Register, 4,173 patients operated on for lumbar disc herniation were evaluated using pre-and 1-year postoperative protocols and complication registration. Mean patient age was 41 (18-81) years and 53% of the patients were male. 93% of the operations were performed on the two lowermost lumbar levels. The incidence of dural lesions in the material was 2.7%. In patients with previous disc surgery, the incidence was doubled, 5%, a significant increase (P = 0.02). Patients with dural lesions preoperatively had more back pain and inferior scores in general health and role emotional domains of the SF-36. These factors, however, were because they had been operated on previously, not related to the dural lesion as such. The relative improvement after surgery was similar whether a dural lesion had occurred or not. It is concluded that a dural lesion is a technical complication which must be solved at the time of surgery but which does not bear any negative implications on the long-term outcome for the patient.

Evaluation of a Modified POSSUM Scoring System for Predicting the Morbidity in Patients Undergoing Lumbar Surgery

“…The operation safety is the most important factor, but with the increase in lumbar surgery, the complication rate increases accordingly. Several studies have reported on complication rates in various types of patients undergoing operative treatment in the lumbar region [3,15,23]. Major complications of lumbar surgery include blood loss, dural tear, hematoma, deep vein thrombosis, wound infection, seroma, stress ulcer, abdominal distension, urinary retention, and pulmonary embolism [9,12].…”

Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome

“…Incidence figures for dural lesions in disc surgeries seem to be in the region of 2-6% [13,16,20] with previous surgery being a strong predictor of the complication. In spinal stenosis surgery higher figures should be expected to be encountered due to the wider exposure of the dural sac and to the difficulties created by ligamentous hypertrophy and osteophytes on the facet joints in decompression especially afflicting the nerve roots but also the central cauda.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2010

“…The one by Strömqvist [47] reports a prospective study from the Swedish Spine Register, dealing with 4,173 patients operated upon for a disc herniation, of whom 2.7% had tears. Although those patients who had dural tears tended to have had previous surgery, the fact that they had a tear did not have any negative implications in the long-term outcome for the patient at 1 year.…”