Risk factors for dural tears in the cervical spine

STUDY DESIGN.: Retrospective review of prospective database. OBJECTIVE.: To investigate the incidence of cervical dural tears (DTs), risk factors for occurrence and failure of treatment, and the effect on clinical outcomes. SUMMARY OF BACKGROUND DATA.: Only 1 study has specifically investigated the impact of cervical DTs. METHODS.: Cervical spine surgical procedures performed by the senior author (K.D.R.) at Washington University from 1995-2012 were evaluated. Demographic data, surgical history, operative data, and complications were recorded prospectively, and retrospectively reviewed. Intraoperative treatment of DTs was noted. Treatment failure was defined by reoperation or delayed lumbar drain placement. Patients who sustained a dural tear (DT group) were compared with those who did not sustain a dural tear (No-DT group) to identify risk factors. Comparison between successful and failed treatments was used to identify risk factors for treatment failure. RESULTS.: A total of 3848 cervical surgical procedures were performed, with 38 occurrences (1.0%) of DT. Risk factors for DT were: older age (P < 0.01), rheumatoid arthritis (relative risk [RR] = 3.1, 95% confidence interval [CI] = 1.0-9.8), ossification of the posterior longitudinal ligament (RR = 19.2, 95% CI = 10.4-35.6), cervical deformity (RR = 3.3, 95% CI = 1.6-6.6), longer operative time (P = 0.01), greater number of surgical levels (P < 0.01), worse preoperative neurological status (P < 0.01), and performance of a corpectomy (RR = 2.1, 95% CI = 1.1-4.0) or revision laminectomy (RR = 20.0, 95% CI = 8.4-47.4). Initial treatments failed in 12 cases (32%) and hospital readmission was required for 5 patients (13%). Older age and ossification of the posterior longitudinal ligament were found to be risk factors for failure of the DT treatment. With an average follow-up of 18 months, there were no clinical sequelae from the DTs. CONCLUSION.: In the largest series of cervical DTs reported, the incidence of DTs was found to be 1% and several risk factors were identified. Initial treatment failures occurred more often than previously reported. No significant clinical impact was found after successful DT treatment.