Outcomes after incidental durotomy during first-time lumbar discectomy

Desai, Atman; Ball, Perry A.; Bekelis, Kimon; Lurie, Jon D.; Mirza, Sohail K.; Tosteson, Tor D.; Weinstein, James Neil

doi:10.3171/2011.1.spine10426

Cited by 67 publications

(62 citation statements)

References 29 publications

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“…One limitation of the SPORT, and therefore this study, is the high crossover rate observed between the operative and nonoperative groups. However, because previous authors found consistencies between cohorts, the data have been combined into an as-treated analysis in many of the studies included in this review [3,5,6,8,9,11,[14][15][16][17][18]. Also, the 8-year followup rate was 63% of the initial subjects, and baseline demographics tended to be favorable to a better outcome in both the surgical and nonoperative groups [10].…”

Section: Discussionmentioning

confidence: 99%

“…Search criteria included ''SPORT'' AND ''disc'' AND ''Spine Patients Outcomes Research Trial,'' which returned 36 articles. Of these, we identified 11 articles that analyzed subgroups of the SPORT patients with IDH [3,5,6,8,9,11,[14][15][16][17][18] (Table 1). A listing of SPORT-related Table 1.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Based on education, there were no differences in improvement for SF-36 bodily pain, SF-36 physical functioning, and ODI (p = 0.54, p = 0.26, and p = 0.088, respectively) [11]. There were also no differences based on durotomy or no durotomy (p = 0.47, p = 0.08, and p = 0.68, respectively) [5] or for those receiving or not receiving epidural steroid injections (p = 0.33, p = 0.81, and p = 0.81, respectively) [16]. There were also no differences in level of improvement for patients using or not using opioids (p = 0.89, p = 0.89, and p = 0.89, respectively) [15].…”

Section: Factors Associated With Improvement In Patientreported Outcomesmentioning

confidence: 99%

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Which Variables Are Associated With Patient-reported Outcomes After Discectomy? Review of SPORT Disc Herniation Studies

Koerner

Glaser

Radcliff

2015

Clinical Orthopaedics &Amp; Related Research

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Background The Spine Patient Outcomes Research Trial (SPORT) evaluated the effects of surgery versus nonoperative treatment for lumbar intervertebral disc herniation (IDH), among other pathologies. Multiple subgroup analyses have been completed since the initial publications, which have further defined which patient factors lead to better or worse patient-reported outcomes; however, the degree to which these factors influence patient-reported outcomes has not been explored. Questions/purposes We reviewed the subgroup analyses of the SPORT IDH studies to answer the following questions: (1) What factors predicted improvement in patientreported outcomes after operative or nonoperative treatment of lumbar IDH? (2) What factors predicted worse patient-reported outcomes compared to baseline after operative or nonoperative treatment of lumbar IDH? And (3) what factors influenced patient-reported outcomes of surgery in patients with lumbar IDH? Methods We conducted a MEDLINE 1 search to identify the subgroup analyses of the SPORT IDH data that were responsive to our study questions. Eleven articles were identified that met our search criteria. Results The patient factors associated with larger improvements in Oswestry Disability Index at 4 years with either surgical or nonoperative treatment included a higher baseline Oswestry Disability Index, BMI of less than 30, not being depressed, being insured, having no litigation pending, not having workers compensation, and having symptoms for less than 6 weeks, though there were others. Factors leading to improvement with surgical treatment were mostly related to anatomic characteristics of the disc herniation such as posterolateral and sequestered herniations. There were no patient or clinical factors identified that were associated with worse patient-reported outcomes compared to baseline after either operative or nonoperative treatment. At 2-year followup, the treatment effects were greater for those patients with upper-level herniations, patients not receiving workers compensation, and nondiabetic patients. In a 4-year multivariate analysis, being married, without joint problems, and having worse symptoms at baseline resulted in greater treatment effect with surgery. Conclusions While most patients with IDH will likely see improvement with either surgical or nonoperative treatment, there are patient-related factors that can help predict which subgroups will demonstrate a greater improvement with surgery, such as not having joint problems, being married, having worsening symptoms at baseline, and not having diabetes. These results can help providers and patients when discussing treatment options.

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Section: Discussionmentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Factors Associated With Improvement In Patientreported Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

Which Variables Are Associated With Patient-reported Outcomes After Discectomy? Review of SPORT Disc Herniation Studies

Koerner

Glaser

Radcliff

2015

Clinical Orthopaedics &Amp; Related Research

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Case Report

A 72 year old man presented with lower back pain extending down the left anterior thigh, one year after an uncomplicated L2-5 laminectomy for lumbar spinal stenosis.

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mentioning

confidence: 99%

“…of arthrodesis is exceedingly rare [6][7][8][9]. We present a case of acute SSDH, presenting with cauda equina after surgical decompression and reconstruction, as well as summarize the current literature on SSDH.…”

mentioning

confidence: 99%

Acute Spinal Subdural Hematoma Subsequent To Posterior Lumbar Fusion

Ali

Barkley²,

Malhotra³

2013

J Osteopor Phys Act

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of arthrodesis is exceedingly rare [6][7][8][9]. We present a case of acute SSDH, presenting with cauda equina after surgical decompression and reconstruction, as well as summarize the current literature on SSDH. Case ReportA 72 year old man presented with lower back pain extending down the left anterior thigh, one year after an uncomplicated L2-5 laminectomy for lumbar spinal stenosis. AbstractObjective: To report a rare case of post-operative cauda equina syndrome subsequent to lumbar decompression and reconstruction, and review the relevant anatomical causes of spinal subdural hematoma. We present a case report of an acute spinal subdural hematoma, following surgical decompression and fusion. The etiology of spinal subdural hematoma after spinal surgery is controversial. We propose that violation of the dural-arachnoid interface is a likely mechanism of this complication. Summary of background data:Spinal subdural hematoma (SSDH) is a very rare postoperative complication of surgical decompression. We report the presentation of acute SSDH presenting with acute cauda equine, following lumbar decompression and reconstruction in a patient lacking risk factors for this rare complication. Methods:A 72 year old man with a history of prior L2-5 laminectomy presented with persistent lower back and left lower extremity radicular pain, due to lumbar spondylosis with foraminal stenosis due to synovial cyst, and lumbar disc herniation. He underwent a revision L2-5 laminectomy with foramintomies, L3-4 synovial cyst resection, and L3-4 posterolateral instrumented fusion. Small incidental duratomy without arachnoid fenestration and without cerebrospinal fluid extravasation, was noted and repaired intraoperatively. On post-operative day four, the patient presented with acute cauda equina syndrome, found to be associated with an acute dorsal lumbar subdural hematoma.Results: After emergent evacuation of the hematoma, patient had immediate resolution of symptoms, and continued to demonstrate dramatic improvement after 1-year follow-up. Conclusions:Despite its low incidence, SSDH should be considered in the setting of acute cauda equina syndrome, following surgical decompression. Prompt evacuation of hematoma is associated with good prognosis. The etiology of SSDH post spinal surgery is controversial. Violation of the dural-arachnoid interface and destruction of local neurothelial cells is the suspected etiology of this very rare complication. Key Points* SSDH is a very rare complication of surgical decompression, with coagulopathy conferring an increased risk.* Although rare, acute SSDH should be considered in the setting of acute cauda equina syndrome, following lumbar decompression associated with intraoperative durotomy, without spinal fluid leak.* Emergent evacuation of SSDH provides greatest chance of good prognosis and reversal of symptoms.* Our case demonstrates that violation of the dural-arachnoid interface is a plausible etiology for postoperative SSDH.

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