Risk factors for incidental durotomy during posterior open spine surgery for degenerative diseases in adults: A multicenter observational study

Ishikura, Hisatoshi; Ogihara, Satoshi; Oka, Hiroyuki; Maruyama, Toru; Inanami, Hirohiko; Miyoshi, Katsuhiko; Matsudaira, Ko; Chikuda, Hirotaka; Azuma, Seiichi; Kawamura, Naohiro; Yamakawa, Kiyofumi; Hara, Nobuhiro; Oshima, Yasushi; Morii, Jiro; Saita, Kazuo; Tanaka, Sakae; Yamazaki, Takashi

doi:10.1371/journal.pone.0188038

Cited by 33 publications

(25 citation statements)

References 21 publications

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“…Some studies have stated that the risk of a dural tear during posterior surgery was from 1.6% to 8%. Debriding the anterior lesion using the posterior approach invades the spinal canal, which increases the risk of infection to the central nervous system after a durotomy.…”

Section: Discussionmentioning

confidence: 99%

One‐stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series

Tong

Liu

Fan

et al. 2019

Orthopaedic Surgery

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ObjectiveSurgery is indicated when antibiotic treatment fails in pyogenic spondylodiscitis, which is caused by pathogens such as the Staphylococcus species. The aim of the present study was to investigate the efficacy and safety of the oblique lateral interbody fusion (OLIF) corridor approach combined with posterior pedicle screw fixation for treating pyogenic spondylodiscitis.MethodsThis was a retrospective case series study. A total of 11 patients with an average age of 60.7 years (range, 40–70 years; 10 males and 1 females) with lumbar pyogenic spondylodiscitis who underwent single‐stage debridement and reconstruction using the OLIF corridor combined with posterior pedicle screw fixation were recruited in our study from June 2016 to July 2017. All patients had single‐level pyogenic spondylodiscitis between T12 and L5. The baseline data, perioperative outcomes (operative time, intra‐operative blood loss, and intra‐operative complication), postoperative laboratory tests (erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP], white blood count [WBC], and tissue culture results), long‐term complications (recurrence, fixation failure, and bony non‐fusion rates), and duration of antibiotic administration were reviewed. Outcomes evaluated using a variety of scales including visual analog scale (VAS) score and Oswestry disability index (ODI), were compared pre‐operatively and post‐operatively.ResultsThe mean follow‐up period of time was 18.3 months. The average operative time and intra‐operative blood loss were 217.0 ± 91.91 min and 220.9 ± 166.10 mL, respectively. There were no intra‐operative complications, except in 1 patient who encountered somatosensory evoked potentials changes and 1 patient who had motor evoked potentials changes, both without post‐surgery neurological deficits. Causative organisms were identified in 4 patients: Staphylococcus aureus in 1 patient and Streptococcus in 3 patients. At approximately 8.8 weeks after surgery, WBC, CRP, and ESR had returned to normal levels. All patients were pain free with no recurring infection. There was no fixation failure during follow up. Solid bony fusions were observed in all cases within 6 months. At the final follow up, the mean VAS (0.6 ± 0.69) and ODI (14.4 ± 4.27) were significantly lower than those before surgery (P < 0.05).ConclusionOne‐stage debridement with autogenous iliac bone graft through the OLIF corridor combined with posterior pedicle screw fixation is effective and safe for single‐level spontaneous lumbar pyogenic spondylodiscitis after antibiotic treatment fails.

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Section: Discussionmentioning

confidence: 99%

One‐stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series

Tong

Liu

Fan

et al. 2019

Orthopaedic Surgery

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“…30 A multi-center study of 4652 patients attempted to identify risk factors for incidental durotomy among adults undergoing posterior open surgery for degenerative diseases. 31 Corrective vertebral osteotomy and revision surgery were identified as independent risk factors, while cervical surgery and discectomy were identified as factors that independently protected against incidental durotomy.…”

Section: Discussionmentioning

confidence: 96%

Incidence and management of incidental durotomy during thoracic and lumbar spine surgeries: a retrospective review in a tertiary care centre

et al. 2018

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Background: Incidental durotomy is among the most common complications of spine surgery with reported incidence ranging from 1.7% to 16%. Various management options including primary repair, fascial or fat graft, epidural blood patch, fibrin glue sealant, etc., have been proposed. The purpose of this study is to evaluate the incidence of incidental durotomy and the efficacy of different management options during a five year period at a tertiary care center.Methods: All patients who underwent various surgical procedures in thoracic and lumbar spine from January 2006 - December 2010 in our centre were retrospectively reviewed. Data on demographics, primary diagnosis, associated co morbidities, details of surgical procedure, training level of the operating surgeon, details of the incidental durotomy, the treatment, complications and the postoperative stay were recorded.Results: Of 2270 patients, 1401 patients were included in the study. The incidence of incidental durotomy was 3.49% (49 patients). We found a very high incidence of 33.33% incidental durotomies among patients who underwent revision procedures as compared to 3.23% for patients who underwent primary surgeries. 5.10% of incidental durotomies were caused by fellows under training, 4.27% by junior consultants and 2.92% by senior consultants. Of 49 durotomies, complication were 5 cases of intracranial hypotension, 5 postoperative neurological deficits, 2 deep wound infection, 2 pseudomeningocele and 1 meningitis.Conclusions: The risk of incidental durotomy in thoracolumbar surgeries is high in revision surgeries and when performed by fellows in training. Intraoperative identification and primary repair with suturing or sealant reduces postoperative complications.

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“…Incidental durotomy, a complication of spine surgery, occurs more frequently in the lumbar spine, especially during revision procedures. Its incidence ranges between 3% and 27% of all spinal operations, [1][2][3] with an apparent predilection for posterior access interventions. 4,5 Posterior spinal arthrodesis, a common procedure, is performed for various indications such as degenerative diseases, trauma, infections, and tumors.…”

Section: Introductionmentioning

confidence: 99%

Incidental Durotomy Following Transforaminal Lumbar Interbody Fusion Performed with the Modified Wiltse Approach

Sheinis

Benharroch

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Purpose Incidental durotomy is an intraoperative complication that occurs in 3 to 27% of lumbar spine surgeries. It has been reported more commonly following revision spinal procedures. Study Objectives To investigate the frequency of incidental durotomy while performing transforaminal lumbar interbody fusion (TLIF) using the modified Wiltse approach. A secondary goal was to compare the incidence of durotomy in patients undergoing primary spine surgery with those undergoing revision surgery. Methods A group of consecutive patients who had undergone (TLIF) in the last 10 years ending in 2015 were enrolled in the study. All patients underwent TLIF via the modified Wiltse approach that included a central midline skin incision, followed by a paravertebral blunt dissection of the paraspinal muscles to reach the transverse processes. The deep paravertebral dissection was done conservatively, one side at a time. Demographic and clinical data were collected when relevant to the comparison. Results The study cohort encompassed 257 patients: 200 primary cases and 57 revisions. The frequency of incidental durotomy was equal in both groups: 3.5% each (7/200 and 2/57). All durotomies were repaired primarily. No other immediate or late complications were observed during follow-up. Conclusion The present study displays a limited incidence of durotomy in the primary interventions and to a lesser degree in the revisions, all of which had used a TLIF performed with the modified Wiltse approach. This procedure probably circumvented the need for further revisions.

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Risk factors for incidental durotomy during posterior open spine surgery for degenerative diseases in adults: A multicenter observational study

Cited by 33 publications

References 21 publications

One‐stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series

One‐stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series

Incidence and management of incidental durotomy during thoracic and lumbar spine surgeries: a retrospective review in a tertiary care centre

Incidental Durotomy Following Transforaminal Lumbar Interbody Fusion Performed with the Modified Wiltse Approach

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