Introduction: A durotomy is one of the possible complications of spinal surgery. Without adequate treatment, durotomy can lead to clinical complications, as well as to longer hospitalization and increased costs. It is useful to have a reference durotomy incidence rate for the evaluation of the relative safety of different surgical aspects. The purpose of this study was to use clinical data, patient discharge databases and the existing literature to estimate the incidence of durotomy. The value of a reference rate is demonstrated by comparison to the durotomy incidence associated with specific bone removal devices: Ultrasonic bone scalpel, high-speed drill and a curved-tip high-speed drill.
Methods: The general incidence of durotomy was estimated by using data extracted from the US National Inpatient Sample (NIS) database and the National Hospital Discharge Survey (NHDS) and from the literature. Several calculation methods of the incidence are presented and discussed. The incidences for the high speed drill and the ultrasonic scalpel devices were derived by combining studies from the literature. The incidence for the curved-tip high-speed drill was calculated from data collected during 221 operative procedures.
Results: The calculated overall incidence was 0.77%-3.77% depending on the method of calculation, lower than the range of 1%-40% reported in smaller studies. The calculated incidences for the high-speed drill, the curved-tip high speed drill and the ultrasonic scalpel were 4.4%, 0.9% and 2.6%, respectively. These results suggest that the ultrasonic scalpel and the curved-tip high speed drill are potentially safer than commonly used methods, with the latter being safer.
Conclusions: The calculated durotomy incidence is affected by the method of evaluation. The choice of bone-removal device can potentially reduce the incidence of this complication. The incidence for the curved-tip high speed drill was relatively low, suggesting that this device offers a potentially safer alternative to traditional techniques.
Patient Care: Incidental durotomy is an important complication of spinal surgery. Estimating durotomy incidence and comparing it to the general incidence and the incidence associated with similar devices or procedures, is highly useful in the development of new surgical devices and techniques.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the significance of dural tears. 2) Be familiar with the incidence of dural tears and relevant contributing factors. 3) Describe the relative safety of the discussed devices.