Influence of unintended dural tears on postoperative outcomes in lumbar surgery patients: a multicenter observational study with propensity scoring

• Published in: The spine journal 2020-12, Vol.20 (12), p.1968-1975
• Main Authors: Nakajima, Koji, Nakamoto, Hideki, Kato, So, Doi, Toru, Matsubayashi, Yoshitaka, Taniguchi, Yuki, Kawamura, Naohiro, Higashikawa, Akiro, Takeshita, Yujiro, Fukushima, Masayoshi, Ono, Takashi, Hara, Nobuhiro, Azuma, Seiichi, Tanaka, Sakae, Oshima, Yasushi
• Format: Article
• Language: English
• Subjects: Dural tear; Durotomy; Dysesthesia; EuroQol 5 Dimension; Lumbar spine; Numbness; Oswestry disability index; Pain; Patient-reported outcome; Satisfaction
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2020.06.009

•Unintended dural tears during lumbar surgery are a common complication.•The outcomes in patients with dural tears were thought to be similar to those in patients without dural tears, but this remains uncertain.•We enrolled 2,146 patients including 166 with dural tears and analyzed the outcomes using propensity score matching.•Patients with dural tears showed almost equivalent postoperative outcomes compared with patient without dural tears. Unintended dural tears (DTs) are common in spinal surgeries. Some authors have reported that the outcomes in lumbar surgery patients with DTs are equivalent to those in patients without DTs, but this remains uncertain. To assess the effect of unintended DTs on postoperative patient-reported outcomes. A multicenter retrospective observational study. We enrolled patients undergoing lumbar spine surgery at eight hospitals between April 2017 and November 2018. We collected data regarding patients’ backgrounds, operative factors, occurrence of unplanned DTs during surgery, postoperative complications, patient-reported outcomes, such as pain or dysesthesia of the lower back, buttock, leg, or plantar area, EuroQol 5 Dimension (EQ-5D), Oswestry Disability Index (ODI) scores, and postoperative satisfaction. We divided the patients into a DT− group (without DTs) and a DT+ group (with DTs). First, multivariate logistic regression analyses were conducted to reveal risk factors for occurrence of DTs. Then, we used propensity score matching to obtain a matched DT− group (mDT− group) and a matched DT+ (mDT+ group). Student's t test was used for comparing continuous variables and Pearson's chi-square test for comparing categorical variables between the two groups. We enrolled 2,146 patients in this study. The number of patients with unintended DTs was 166 (7.7%). Older age, body mass index, ossification of posterior longitudinal ligament / yellow ligament, spinal deformity, and revision surgery were significant risk factors for DTs. We used propensity score matching to compare 163 of the patients with DTs with 163 patients without DTs. No significant difference was found in postoperative pain or dysesthesia of the lower back, buttock, leg, and plantar area between the mDT− and mDT+ groups. When comparing preoperative with postoperative pain and dysesthesia, a statistically significant improvement was found in each group (p