title: Incidental durotomy during spinal surgery: a multivariate analysis for risk factors.
abstract: METHODS
  Multivariate analysis.
  
  
  OBJECTIVE
  The purpose of this study was to investigate risk factors for incidental durotomy (ID) in modern spine surgery techniques.
  
  
  BACKGROUND
  ID, a relatively common complication of spine surgery, has been associated with postoperative complications such as durocutaneous fistulas, pseudomeningoceles, and arachnoiditis. Revision surgery may be necessary if the dural tear is not recognized and repaired during the initial procedure.
  
  
  METHODS
  ID was prospectively documented in patients who underwent spine surgery at a single institution during a 2-year period (n=4822). Patients with ID (n=182) from lumbar or thoracolumbar cases were matched 1:1 to a control cohort without ID. Demographic, diagnostic, and surgical procedure data were retrospectively collected and analyzed.
  
  
  RESULTS
  Multivariate analysis identified revision spine surgery (adjusted odds ratio [aOR]: 4.78, 95% confidence interval [CI]: 2.84-8.06, P<0.01), laminectomy (aOR: 3.82, 95% CI: 2.02-7.22, P<0.01), and older age (aOR: 1.03, 95% CI: 1.01-1.04, P<0.01) as independent risk factors for ID. Fusion (aOR: 0.59, 95% CI: 0.35-0.99, P=0.04), foraminectomy, (aOR: 0.42, 95% CI: 0.25-0.69, P<0.01), and lateral approach (aOR: 0.29, 95% CI: 0.14-0.61, P<0.01) were independent protective factors.
  
  
  CONCLUSIONS
  Prior spine surgery, laminectomy, and older age were significant independent risk factors for ID. The recently developed lateral approach to interbody fusion was identified as a significant protective factor for ID, along with fusion and foraminectomy. These findings may help guide future surgical decisions regarding ID and aid in the patient informed-consent process.
  
  
  METHODS
  3.
authors.affiliation: From the Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York City, NY.
authors.forename: Jerry Y
authors.initials: JY
authors.lastname: Du
authors.forename: Alexander
authors.initials: A
authors.lastname: Aichmair
authors.forename: Janina
authors.initials: J
authors.lastname: Kueper
authors.forename: Cyrena
authors.initials: C
authors.lastname: Lam
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Nguyen
authors.forename: Frank P
authors.initials: FP
authors.lastname: Cammisa
authors.forename: Darren R
authors.initials: DR
authors.lastname: Lebl
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004388:Dura Mater / Q000293:injuries*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D007796:Laminectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000601:surgery*; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D013122:Spinal Diseases / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D055815:Young Adult