The Long-term Clinical Sequelae of Incidental Durotomy in Lumbar Disc Surgery

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Study Design.A retrospective, long-term follow-up study.Objectives.To find out whether incidental durotomy in lumbar disc surgery is associated with long-term sequelae.Summary of Background Data.Incidental durotomy is a frequent complication during spinal surgery. Little is known about the clinical long-term outcome.Methods.The study population comprised 1,280 patients who underwent standard discectomy of a lumbar disc herniation. A total of 41 patients with incidental durotomies (Group A) were compared with a control group (n = 41) (Group B) matched for age, sex, spinal level, and duration of follow-up. After a mean follow-up period of 10.2 years (Group A) or 10.3 years (Group B), the patients reported complaints, headache, and low back or leg pain. The patients’ activity was assessed by means of a questionnaire concerning hindrance in daily activities, the Tegner score for general activities in daily life, and the Hannover Functional Ability Questionnaire for Measuring Back Pain-Related Functional Limitations (FFbH–R). The frequency of reoperation and the intake of analgesics were included. Furthermore, the patients’ inability to work, change of profession, and retirement were registered.Results.Patients with incidental durotomy had a poorer outcome after surgery. The Tegner score was significantly decreased for the group with dural tears. Furthermore, significant more patients with incidental durotomy complained about headaches after surgery. A strong tendency for worse outcome in Group A was shown in regard to reported complaints and daily activity. The patients with incidental durotomy had a tendency to more reoperations, a longer duration of inability to work, more back-pain, and functional limitations related to back-pain (FFbH-R).Conclusion.Our study revealed that incidental durotomy in lumbar disc surgery was associated with long-term clinical sequelae. We therefore conclude that dural tears bring about poor clinical outcome at the long-term follow-up.

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