Treatment of dural tears associated with spinal surgery.

Eismont, Frank J.; Wiesel, Samuel W.; Rothman, Richard H.

doi:10.2106/00004623-198163070-00010

Cited by 285 publications

(165 citation statements)

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“…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. Most previous studies on dural lesions refer to spinal surgery in general [6,8,12,19] but a large series from the Scoliosis Research Society [7] demonstrated an incidence of dural lesions of 3% but in this study patients previously operated on in the lumbar spine were excluded. Incidence figures reported must be regarded as minimum figures but most likely are more correct in prospective than in retrospective studies.…”

Section: Discussionmentioning

confidence: 95%

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

2011

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Introduction Decompression for lumbar spinal stenosis is one of the most frequent operations on the spine today. The most common complication seems to be a peroperative dural lesion. There are few prospective studies on this complication regarding incidence and effect on long-term outcome; this is the background for the current study. Materials and methods Swespine, the Swedish Spine Register documents the majority ([80%) of lumbar spine operations in Sweden today. Within the framework of this register, totally 3,699 operations for spinal stenosis during a 5-year period were studied regarding complications and 1-year postoperative outcome. Mean patient age was 66 (37-92) years and 44% were males. Fourteen percent were smokers and 19% had undergone previous lumbar spine surgery. Results The overall incidence of a peroperative dural lesion was 7.4%, 8.5% of patients undergoing decompressive surgery only and 5.5% of patients undergoing decompressive surgery ? fusion (p \ 0.001). A logistic regression analysis demonstrated that (high) age (p \ 0.0004), previous surgery (p \ 0.036) and smoking (p \ 0.049) were significantly predictive factors for dural lesions. An odds ratio estimate demonstrated an age-related risk increase with 2.7% per year. The risk for dural lesions also increased with number of levels decompressed. The 1-year outcome was identical in the two groups with and without a dural lesion.Conclusion A dural lesion was seen in 7.4% of decompressive operations for spinal stenosis. High age, previous surgery and smoking were risk factors for sustaining a lesion, which, however, did not affect the 1-year outcome negatively.

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Section: Discussionmentioning

confidence: 95%

“…In the large prospective SPORT study an incidence of 5% is presented [21]. Whether or not a dural lesion peroperatively is a predictor of inferior outcome of surgery is also subject to some controversy [3,6,19].…”

Section: Introductionmentioning

confidence: 99%

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

2011

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“…The risk increase varies between double and fivefold [5,9] and in the paper of Cammisa et al [3], 38% of those with dural lesions had been subjected to 1-6 procedures on the lumbar spine previously. It seems that the risk is higher for less experienced surgeons [15].…”

Section: Discussionmentioning

confidence: 99%

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

2009

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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.

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“…[5][6][7][8] The causes of dural tear during primary operation include eroded or thin dura, dura adhesion, and redundant dura in patients diagnosed with a tight spinal stenosis. It is particularly prevalent in patients who have epidural fibrosis and scar tissue adherent to the dura during revision of spine surgery.…”

Section: Discussionmentioning

confidence: 99%