No difference in postoperative complications, pain, and functional outcomes up to 2 years after incidental durotomy in lumbar spinal fusion: A prospective, multi-institutional, propensity-matched analysis of 1,741 patients

Owoicho Adogwa, Mary I. Huang, Paul M. Thompson, Timothy Darlington, Joseph S. Cheng, Ziya L. Gokaslan, Oren N. Gottfried, Carlos A. Bagley, Greg D. Anderson, Robert E. Isaacs

Research output: Contribution to journalArticle

Abstract

Background Incidental durotomies occur in up to 17% of spinal operations. Controversy exists regarding the short- and long-term consequences of durotomies. Purpose The primary aim of this study was to assess the effect of incidental durotomies on the immediate postoperative complications and patient-reported outcome measures. Study design Prospective study. Patient sample A total of 1,741 patients undergoing index lumbar spine fusion were selected from a multi-institutional prospective data registry. Outcome measures Patient-reported outcome measures used in this study included back pain (BP-Visual Analog Scale), leg pain (LP-Visual Analog Scale), and Oswestry Disability Index. Methods A total of 1,741 patients were selected from a multi-institutional prospective data registry, who underwent primary lumbar fusion for low back pain and/or radiculopathy between January 2003 and December 2010. We collected and analyzed data on patient demographics, postoperative complications, back pain, leg pain, and functional disability over 2 years, with risk-adjusted propensity score modeling. Results Incidental durotomies occurred in 70 patients (4%). Compared with the control group (n=1,671), there was no significant difference in postoperative infection (p=.32), need for reoperation (p=.85), or symptomatic neurologic damage (p=.66). At 1- and 2-year follow-up, there was no difference in patient-reported outcomes of back pain (BP-Visual Analog Scale), leg pain (LP-Visual Analog Scale), or functional disability (Oswestry Disability Index) (p>.3), with results remaining consistent in the propensity-matched cohort analysis (p>.4). Conclusion Within the context of an on-going debate on the consequences of incidental durotomy, we found no difference in neurologic symptoms, infection, reoperation, back pain, leg pain, or functional disability over a 2-year follow-up period.

Original languageEnglish (US)
Pages (from-to)1828-1834
Number of pages7
JournalSpine Journal
Volume14
Issue number9
DOIs
StatePublished - Sep 1 2014

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Spinal Fusion
Postoperative Pain
Back Pain
Leg
Pain Measurement
Visual Analog Scale
Reoperation
Registries
Pain
Propensity Score
Radiculopathy
Neurologic Manifestations
Low Back Pain
Infection
Nervous System
Spine
Cohort Studies
Demography
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • Complications
  • CSF leak
  • Functional outcomes
  • Incidental durotomy
  • Long-term outcomes
  • Patient reported outcomes

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

No difference in postoperative complications, pain, and functional outcomes up to 2 years after incidental durotomy in lumbar spinal fusion : A prospective, multi-institutional, propensity-matched analysis of 1,741 patients. / Adogwa, Owoicho; Huang, Mary I.; Thompson, Paul M.; Darlington, Timothy; Cheng, Joseph S.; Gokaslan, Ziya L.; Gottfried, Oren N.; Bagley, Carlos A.; Anderson, Greg D.; Isaacs, Robert E.

In: Spine Journal, Vol. 14, No. 9, 01.09.2014, p. 1828-1834.

Research output: Contribution to journalArticle

Adogwa, Owoicho ; Huang, Mary I. ; Thompson, Paul M. ; Darlington, Timothy ; Cheng, Joseph S. ; Gokaslan, Ziya L. ; Gottfried, Oren N. ; Bagley, Carlos A. ; Anderson, Greg D. ; Isaacs, Robert E. / No difference in postoperative complications, pain, and functional outcomes up to 2 years after incidental durotomy in lumbar spinal fusion : A prospective, multi-institutional, propensity-matched analysis of 1,741 patients. In: Spine Journal. 2014 ; Vol. 14, No. 9. pp. 1828-1834.
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abstract = "Background Incidental durotomies occur in up to 17{\%} of spinal operations. Controversy exists regarding the short- and long-term consequences of durotomies. Purpose The primary aim of this study was to assess the effect of incidental durotomies on the immediate postoperative complications and patient-reported outcome measures. Study design Prospective study. Patient sample A total of 1,741 patients undergoing index lumbar spine fusion were selected from a multi-institutional prospective data registry. Outcome measures Patient-reported outcome measures used in this study included back pain (BP-Visual Analog Scale), leg pain (LP-Visual Analog Scale), and Oswestry Disability Index. Methods A total of 1,741 patients were selected from a multi-institutional prospective data registry, who underwent primary lumbar fusion for low back pain and/or radiculopathy between January 2003 and December 2010. We collected and analyzed data on patient demographics, postoperative complications, back pain, leg pain, and functional disability over 2 years, with risk-adjusted propensity score modeling. Results Incidental durotomies occurred in 70 patients (4{\%}). Compared with the control group (n=1,671), there was no significant difference in postoperative infection (p=.32), need for reoperation (p=.85), or symptomatic neurologic damage (p=.66). At 1- and 2-year follow-up, there was no difference in patient-reported outcomes of back pain (BP-Visual Analog Scale), leg pain (LP-Visual Analog Scale), or functional disability (Oswestry Disability Index) (p>.3), with results remaining consistent in the propensity-matched cohort analysis (p>.4). Conclusion Within the context of an on-going debate on the consequences of incidental durotomy, we found no difference in neurologic symptoms, infection, reoperation, back pain, leg pain, or functional disability over a 2-year follow-up period.",
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T1 - No difference in postoperative complications, pain, and functional outcomes up to 2 years after incidental durotomy in lumbar spinal fusion

T2 - A prospective, multi-institutional, propensity-matched analysis of 1,741 patients

AU - Adogwa, Owoicho

AU - Huang, Mary I.

AU - Thompson, Paul M.

AU - Darlington, Timothy

AU - Cheng, Joseph S.

AU - Gokaslan, Ziya L.

AU - Gottfried, Oren N.

AU - Bagley, Carlos A.

AU - Anderson, Greg D.

AU - Isaacs, Robert E.

PY - 2014/9/1

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N2 - Background Incidental durotomies occur in up to 17% of spinal operations. Controversy exists regarding the short- and long-term consequences of durotomies. Purpose The primary aim of this study was to assess the effect of incidental durotomies on the immediate postoperative complications and patient-reported outcome measures. Study design Prospective study. Patient sample A total of 1,741 patients undergoing index lumbar spine fusion were selected from a multi-institutional prospective data registry. Outcome measures Patient-reported outcome measures used in this study included back pain (BP-Visual Analog Scale), leg pain (LP-Visual Analog Scale), and Oswestry Disability Index. Methods A total of 1,741 patients were selected from a multi-institutional prospective data registry, who underwent primary lumbar fusion for low back pain and/or radiculopathy between January 2003 and December 2010. We collected and analyzed data on patient demographics, postoperative complications, back pain, leg pain, and functional disability over 2 years, with risk-adjusted propensity score modeling. Results Incidental durotomies occurred in 70 patients (4%). Compared with the control group (n=1,671), there was no significant difference in postoperative infection (p=.32), need for reoperation (p=.85), or symptomatic neurologic damage (p=.66). At 1- and 2-year follow-up, there was no difference in patient-reported outcomes of back pain (BP-Visual Analog Scale), leg pain (LP-Visual Analog Scale), or functional disability (Oswestry Disability Index) (p>.3), with results remaining consistent in the propensity-matched cohort analysis (p>.4). Conclusion Within the context of an on-going debate on the consequences of incidental durotomy, we found no difference in neurologic symptoms, infection, reoperation, back pain, leg pain, or functional disability over a 2-year follow-up period.

AB - Background Incidental durotomies occur in up to 17% of spinal operations. Controversy exists regarding the short- and long-term consequences of durotomies. Purpose The primary aim of this study was to assess the effect of incidental durotomies on the immediate postoperative complications and patient-reported outcome measures. Study design Prospective study. Patient sample A total of 1,741 patients undergoing index lumbar spine fusion were selected from a multi-institutional prospective data registry. Outcome measures Patient-reported outcome measures used in this study included back pain (BP-Visual Analog Scale), leg pain (LP-Visual Analog Scale), and Oswestry Disability Index. Methods A total of 1,741 patients were selected from a multi-institutional prospective data registry, who underwent primary lumbar fusion for low back pain and/or radiculopathy between January 2003 and December 2010. We collected and analyzed data on patient demographics, postoperative complications, back pain, leg pain, and functional disability over 2 years, with risk-adjusted propensity score modeling. Results Incidental durotomies occurred in 70 patients (4%). Compared with the control group (n=1,671), there was no significant difference in postoperative infection (p=.32), need for reoperation (p=.85), or symptomatic neurologic damage (p=.66). At 1- and 2-year follow-up, there was no difference in patient-reported outcomes of back pain (BP-Visual Analog Scale), leg pain (LP-Visual Analog Scale), or functional disability (Oswestry Disability Index) (p>.3), with results remaining consistent in the propensity-matched cohort analysis (p>.4). Conclusion Within the context of an on-going debate on the consequences of incidental durotomy, we found no difference in neurologic symptoms, infection, reoperation, back pain, leg pain, or functional disability over a 2-year follow-up period.

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KW - CSF leak

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KW - Long-term outcomes

KW - Patient reported outcomes

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