title: Incidental dural tear in cervical spine surgery: analysis of a nationwide database.
abstract: METHODS
  This was a retrospective study.
  
  
  OBJECTIVE
  To report the incidence of incidental dural tear (DT) in cervical spine surgery, risk factors, and in-hospital patient outcomes on a national level.
  
  
  BACKGROUND
  DT during cervical spine surgery is not as common as that during lumbar spine surgery; however, DT is still a difficult complication.
  
  
  METHODS
  Clinical data were obtained from the US Nationwide Inpatient Sample for 2009. Patients who underwent cervical spine surgery were identified and divided into those with and without DT according to the International Classification of Diseases, 9th revision, Clinical Modification codes. The patient and health care system-related demographic data were retrieved. The incidence of DT and patient outcomes were analyzed. A multivariate logistic regression analysis was performed to identify the risk factors for DT.
  
  
  RESULTS
  The incidence of DT was 0.45% (855/190,021). The multivariate analysis revealed that a diagnosis of myelopathy and ossification of the posterior longitudinal ligament; posterior approach, anterior and posterior approach; and insurance status were the significant risk factors for DT. Comparison between patients with and without DT showed that those with DT had significantly higher overall in-hospital complications (21.6% vs. 7.3%), longer hospital stays (6.0 vs. 3.2 d), a lower proportion who were discharged home routinely (66.3% vs. 83.9%), increased total hospital costs ($96,424 vs. $62,416), and similar in-hospital mortality (0.6% vs. 0.4%).
  
  
  CONCLUSIONS
  The incidence of DT in cervical spine surgery was 0.45% in the United States. The risk of DT was highest with a primary diagnosis of the ossification of the posterior longitudinal ligament (58.4 times). DT significantly increased the rate of in-hospital complications and health care burden.
authors: *Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY †Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.
authors: Hiroyuki
authors: H
authors: Yoshihara
authors: Daisuke
authors: D
authors: Yoneoka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D019992:Databases as Topic; D003710:Demography; D004388:Dura Mater / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult