The long-term clinical sequelae of incidental durotomy in lumbar disc surgery.
METHODS
A retrospective, long-term follow-up study.


OBJECTIVE
To find out whether incidental durotomy in lumbar disc surgery is associated with long-term sequelae.


BACKGROUND
Incidental durotomy is a frequent complication during spinal surgery. Little is known about the clinical long-term outcome.


METHODS
The study population comprised 1,280 patients who underwent standard discectomy of a lumbar disc herniation. A total of 41 patients with incidental durotomies (Group A) were compared with a control group (n = 41) (Group B) matched for age, sex, spinal level, and duration of follow-up. After a mean follow-up period of 10.2 years (Group A) or 10.3 years (Group B), the patients reported complaints, headache, and low back or leg pain. The patients' activity was assessed by means of a questionnaire concerning hindrance in daily activities, the Tegner score for general activities in daily life, and the Hannover Functional Ability Questionnaire for Measuring Back Pain-Related Functional Limitations (FFbH-R). The frequency of reoperation and the intake of analgesics were included. Furthermore, the patients' inability to work, change of profession, and retirement were registered.


RESULTS
Patients with incidental durotomy had a poorer outcome after surgery. The Tegner score was significantly decreased for the group with dural tears. Furthermore, significant more patients with incidental durotomy complained about headaches after surgery. A strong tendency for worse outcome in Group A was shown in regard to reported complaints and daily activity. The patients with incidental durotomy had a tendency to more reoperations, a longer duration of inability to work, more back-pain, and functional limitations related to back-pain (FFbH-R).


CONCLUSIONS
Our study revealed that incidental durotomy in lumbar disc surgery was associated with long-term clinical sequelae. We therefore conclude that dural tears bring about poor clinical outcome at the long-term follow-up.
Saxler
Guido
G
Department of Orthopaedic Surgery, University of Duisburg-Essen, Essen, Germany. guido.saxler@uni-essen.de
Krämer
Jürgen
J
Barden
Bertram
B
Kurt
Asik
A
Pförtner
Jörg
J
Bernsmann
Kai
K
D000041:Absenteeism; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001416:Back Pain / Q000209:etiology / Q000503:physiopathology; D017586:Diskectomy / Q000009:adverse effects*; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000503:physiopathology / Q000601:surgery*; D022125:Lacerations / Q000150:complications / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies