title: Incidence of unintended durotomy in spine surgery based on 108,478 cases.
abstract: BACKGROUND
  Unintended durotomy is a common complication of spinal surgery. However, the incidences reported in the literature vary widely and are based primarily on relatively small case numbers from a single surgeon or institution.
  
  
  OBJECTIVE
  To provide spine surgeons with a reliable incidence of unintended durotomy in spinal surgery and to assess various factors that may influence the risk of durotomy.
  
  
  METHODS
  We assessed 108,478 surgical cases prospectively submitted by members of the Scoliosis Research Society to a deidentified database from 2004 to 2007.
  
  
  RESULTS
  Unintended durotomy occurred in 1.6% (1745 of 108 478) of all cases. The incidence of unintended durotomy ranged from 1.1% to 1.9% on the basis of preoperative diagnosis, with the highest incidence among patients treated for kyphosis (1.9%) or spondylolisthesis (1.9%) and the lowest incidence among patients treated for scoliosis (1.1%). The most common indication for spine surgery was degenerative spinal disorder, and among these patients, there was a lower incidence of durotomy for cervical (1.0%) vs thoracic (2.2%; P = .01) or lumbar (2.1%, P < .001) cases. Scoliosis procedures were further characterized by etiology, with the highest incidence of durotomy in the degenerative subgroup (2.2% vs 1.1%; P < .001). Durotomy was more common in revision compared with primary surgery (2.2% vs 1.5%; P < .001) and was significantly more common among elderly (> 80 years of age) patients (2.2% vs 1.6%; P = .006). There was a significant association between unintended durotomy and development of a new neurological deficit (P < .001).
  
  
  CONCLUSIONS
  Unintended durotomy occurred in at least 1.6% of spinal surgeries, even among experienced surgeons. Our data provide general benchmarks of durotomy rates and serve as a basis for ongoing efforts to improve safety of care.
authors.affiliation: University of Virginia Medical Center, Charlottesville, Virginia 22908, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Williams
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sansur
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Sigurd H
authors.initials: SH
authors.lastname: Berven
authors.forename: Paul A
authors.initials: PA
authors.lastname: Broadstone
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Choma
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goytan
authors.forename: Hilali H
authors.initials: HH
authors.lastname: Noordeen
authors.forename: D Raymond
authors.initials: DR
authors.lastname: Knapp
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
authors.forename: Reinhard D
authors.initials: RD
authors.lastname: Zeller
authors.forename: William F
authors.initials: WF
authors.lastname: Donaldson
authors.forename: David W
authors.initials: DW
authors.lastname: Polly
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Perra
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D013122:Spinal Diseases / Q000601:surgery*; D055815:Young Adult