title: Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Swedish Society of Spinal Surgeons, Department of Orthopedics, Clinical Sciences Lund, Lund University Hospital, Lund University, SE-221 85 Lund, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Strömqvist
authors.forename: Bo
authors.initials: B
authors.lastname: Jönsson
authors.forename: Björn
authors.initials: B
authors.lastname: Strömqvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001363:Awards and Prizes; D019299:Decompression, Surgical / Q000009:adverse effects*; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000453:epidemiology* / Q000209:etiology; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome