Dural tears in primary decompressive lumbar surgery. Is primary repair necessary for a good outcome?
METHODS
Case control series with prospective data collection.


OBJECTIVE
To establish whether incidental durotomy treated without primary suture repair adversely affects the outcome following lumbar surgery in the longer term.


METHODS
Outcome scores from a prospective database were used for an audit of dural tears in primary lumbar decompressive surgery. Outcome data collected includes the Short Form 36 General Health Questionnaire (SF36), the Oswestry Disability Index (ODI) and Visual Analogue Scores for leg pain (VAL) and back pain (VAB).


RESULTS
Out of 200 consecutive procedures, a dural tear occurred in 19 (9.5%) patients. Of 19 patients with a dural tear, data was incomplete in 4 patients, and 1 further patient who had their dural tear sutured was excluded, leaving 14 patients to be studied. There were seven males and seven females, with an average age of 50.8 years (31-69). These 14 patients (group 1) were compared to a matched group (age, sex, surgical diagnosis and duration of follow-up) of 14 patients (group 2) with no tear. Both groups had similar pre-operative scores. At 6-month follow-up, both groups had significant improvements in all outcomes measures except for the general health domain of the SF-36. At final follow-up, patients with dural tears appeared to have better improvements in outcome measures amongst the VAB, VAL and ODI with similar scores in the SF-36 domains.


CONCLUSIONS
Our study demonstrates that incidental durotomy in primary lumbar decompressive surgery can be successfully managed without primary suture repair with no adverse effect on surgical outcome in the longer term.
Department of Orthopaedic Surgery , University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, United Kingdom, sgrnnm@aol.com.
Sean
S
Grannum
Mohammed Shakil
MS
Patel
Fahad
F
Attar
Martyn
M
Newey
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016208:Databases, Factual; D019299:Decompression, Surgical / Q000009:adverse effects*; D017586:Diskectomy / Q000009:adverse effects*; D004388:Dura Mater / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D013536:Suture Techniques; D016896:Treatment Outcome