title: No difference in postoperative complications, pain, and functional outcomes up to 2 years after incidental durotomy in lumbar spinal fusion: a prospective, multi-institutional, propensity-matched analysis of 1,741 patients.
abstract: BACKGROUND
  Incidental durotomies occur in up to 17% of spinal operations. Controversy exists regarding the short- and long-term consequences of durotomies.
  
  
  OBJECTIVE
  The primary aim of this study was to assess the effect of incidental durotomies on the immediate postoperative complications and patient-reported outcome measures.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  A total of 1,741 patients undergoing index lumbar spine fusion were selected from a multi-institutional prospective data registry.
  
  
  METHODS
  Patient-reported outcome measures used in this study included back pain (BP-Visual Analog Scale), leg pain (LP-Visual Analog Scale), and Oswestry Disability Index.
  
  
  METHODS
  A total of 1,741 patients were selected from a multi-institutional prospective data registry, who underwent primary lumbar fusion for low back pain and/or radiculopathy between January 2003 and December 2010. We collected and analyzed data on patient demographics, postoperative complications, back pain, leg pain, and functional disability over 2 years, with risk-adjusted propensity score modeling.
  
  
  RESULTS
  Incidental durotomies occurred in 70 patients (4%). Compared with the control group (n=1,671), there was no significant difference in postoperative infection (p=.32), need for reoperation (p=.85), or symptomatic neurologic damage (p=.66). At 1- and 2-year follow-up, there was no difference in patient-reported outcomes of back pain (BP-Visual Analog Scale), leg pain (LP-Visual Analog Scale), or functional disability (Oswestry Disability Index) (p>.3), with results remaining consistent in the propensity-matched cohort analysis (p>.4).
  
  
  CONCLUSIONS
  Within the context of an on-going debate on the consequences of incidental durotomy, we found no difference in neurologic symptoms, infection, reoperation, back pain, leg pain, or functional disability over a 2-year follow-up period.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, 1000 Trent Drive, Room 4517 Busse Bldg, Durham, NC 27710, USA. Electronic address: owoicho.adogwa@gmail.com.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, 1000 Trent Drive, Room 4517 Busse Bldg, Durham, NC 27710, USA.
authors.forename: Mary I
authors.initials: MI
authors.lastname: Huang
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, 1000 Trent Drive, Room 4517 Busse Bldg, Durham, NC 27710, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Thompson
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, 1000 Trent Drive, Room 4517 Busse Bldg, Durham, NC 27710, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Darlington
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 23108, Nashville, TN 37204, USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, 1000 Trent Drive, Room 4517 Busse Bldg, Durham, NC 27710, USA.
authors.forename: Oren N
authors.initials: ON
authors.lastname: Gottfried
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, 1000 Trent Drive, Room 4517 Busse Bldg, Durham, NC 27710, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.affiliation: Department of Orthopaedic and Neurological Surgery, Rothman Institute, Thomas Jefferson University Hospitals, 170 North Henderson Rd, King of Prussia, PA 19406, USA.
authors.forename: Greg D
authors.initials: GD
authors.lastname: Anderson
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, 1000 Trent Drive, Room 4517 Busse Bldg, Durham, NC 27710, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D019300:Medical Errors / Q000009:adverse effects*; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology*; D057216:Propensity Score; D011446:Prospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: CSF leak; Complications; Functional outcomes; Incidental durotomy; Long-term outcomes; Patient reported outcomes