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  • Pain and Functional Outcomes After Incidental Durotomy in Lumbar Spine Surgery: A Propensity Matched Prospective, Multi-Institutional Longitudinal Study of 1,741 Patients

    Final Number:

    Owoicho Adogwa M.D. M.P.H; Paul Thompson BS; Terence Verla; Ulysses Null; Kemp Knott BS; Kevin T. Huang BA; Joseph S. Cheng MD, MS; Robert E. Isaacs MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Incidental durotomies are a frequent complication during spinal surgery, with a reported incidence ranging from 1% to 17%. Despite the frequency of spinal surgery and the concomitant high incidence of durotomy, there is a paucity of studies assessing the effect of incidental durotomies on long-term patient reported outcomes

    Methods: A nationwide, multi-institutional, prospective spine outcomes registry was utilized for this study. In total, 1,741 patients were included; a total of 70 (4.02%) patients with incidental durotomies (Group A) were compared with a control group (n=1671) (Group B). Patients completed the Oswestry Disability Index (ODI) questionnaire and back and leg pain numerical rating scores before surgery, then at 3, 6, 12, and 24 months after surgery. One- and two-year patient reported outcomes and complication rates were compared between both patient cohorts. Propensity score modeling produced a matched cohort balanced on age, gender, comorbidities, and other relevant surgical factors.

    Results: Both cohorts were similar at baseline, Table 1. Statistically significant improvements from baseline were observed in both cohorts in all patient reported outcome measures(ODI,VAS-LP, VAS-BP). Both Group A and Group B cohorts demonstrated similar 2-year improvement in VAS for back pain, VA for leg pain, and Oswestry Disability Index, Table 2. In the propensity matched cohort analysis, similar 2-year improvement in VAS for back pain, VAS for leg pain, and Oswestry Disability Index was observed in both patients cohorts, Table 3.

    Conclusions: Our study suggest that incidental durotomy during index spine surgery was not associated with inferior long-term outcomes. Compared with the control group, patients in the durotomy cohort reported similar clinical benefit after lumbar spine surgery, with no observed difference in the extent of pain and functional improvement.

    Patient Care: This research will show the effect of a common complication of surgery on long term patient health.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the association between incidental durotomy and long term outcomes after spine surgery.


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