Incidental durotomy in lumbar decompressive surgery: incidence and risk-factors, and the effect of durotomy on hospital and patient metrics.

JH, Geere, Hunter, Paul, Marjoram, T and AS, Rai (2025) Incidental durotomy in lumbar decompressive surgery: incidence and risk-factors, and the effect of durotomy on hospital and patient metrics. European Spine Journal. ISSN 0940-6719

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Abstract

Purpose: To evaluate incidental lumbar durotomy incidence and risk-factors, and the association of durotomy with perioperative metrics and patient-reported outcomes. Methods: A total 3140 cases of 1–3 level elective decompressive surgery from 2008 to 2023 at a single centre were included. Multivariable analysis was performed on literature derived variables to identify independent risk-factors for durotomy. Absolute difference or absolute risk increase (ARI) between durotomy and non-durotomy perioperative metrics was calculated. The association between durotomy and 3-month or 12-month patient-reported outcome measures was assessed. Results: All-procedure durotomy incidence was 4.5% (142/3140). Durotomy risk-factors were age (odds ratio (OR) 1.016, 95% confidence intervals (95% CI) 1.011–1.020), female (OR 1.48, 95% CI 1.26–1.74), number of operative levels (two-level OR 1.81, 95% CI 1.48–2.21; three-level OR 3.18, 95% CI 2.14–4.72), multiple versus no previous operation (OR 1.85, 95% CI 1.11–3.07), and fusion with discectomy versus discectomy (OR 2.36, 95% CI 1.90–2.93). Durotomy was associated with longer length of stay (∆2.4 days, p < 0.001), longer operative time (∆21 min, p < 0.001), and higher rate of iatrogenic nerve injury (ARI 4.3%, p < 0.001), 30-day return to theatre (ARI 5.7%, p < 0.001), and 30-day readmission (ARI 4.4%, p = 0.002). Durotomy was not associated with poorer patient-reported outcomes. Conclusion: Dural tears are often under-reported and are associated with longer hospital stay, increased operative time, and rare perioperative complications which increase healthcare costs. Dural tears did not, however, detrimentally affect patient-reported disability or pain outcomes.

Item Type:	Article
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School University of East Anglia Research Groups/Centres > Theme - ClimateUEA
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Social Sciences > Research Centres > Water Security Research Centre Faculty of Medicine and Health Sciences > Research Centres > Public Health
Related URLs:	http://europepmc.org/abstract/med/396817...
Depositing User:	LivePure Connector
Date Deposited:	09 Jun 2026 12:33
Last Modified:	09 Jun 2026 12:33
URI:	https://ueaeprints.uea.ac.uk/id/eprint/103330
DOI:	10.1007/s00586-024-08620-z

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