Long-Term Results of Lumbar Spine Surgery Complicated by Unintended Incidental Durotomy

Background: Peri-operative adverse events (AE) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes. The purpose of this study is to examine peri-operative AEs and their impact on outcome after lumbar spine surgery. Methods: 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3,12, and 24 months post-operatively included the Owestry Disability Index (ODI), SF-12 Physical (PCS) and Mental (MCS) scales, visual analog scale (VAS) leg and back, Euroqol-5D (EQ5D), and satisfaction. Results: Adverse events occurred in 767 (21.6%) patients, 85 (2.4%) suffered major AEs. Patients with major AEs had worse OD (physical disability) scores and did not reach minimum clinically important differences at 2 years (no AE 25.7±19.2, major: 36.4±19.1, p<0.001). Major AEs were associated with worse ODI (physical disability) scores on multivariable linear regression (p=0.011). Conclusions: Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing adverse events.

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The Effect of Perioperative Adverse Events on Long-Term Patient-Reported Outcomes After Lumbar Spine Surgery

Neurosurgery ◽

10.1093/neuros/nyaa427_s095 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S95-S95

Author(s):

Oliver G S Ayling ◽

Tamir Ailon ◽

John T Street ◽

Nicolas Dea ◽

Greg McIntosh ◽

...

Keyword(s):

Lumbar Spine ◽

Adverse Events ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Lumbar Spine Surgery ◽

Patient Reported

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Incidental durotomy in lumbar spine surgery—a three-nation survey to evaluate its management

Acta Neurochirurgica ◽

10.1007/s00701-014-2177-7 ◽

2014 ◽

Vol 156 (9) ◽

pp. 1813-1820 ◽

Cited By ~ 27

Author(s):

Oliver P. Gautschi ◽

Martin N. Stienen ◽

Nicolas R. Smoll ◽

Marco V. Corniola ◽

Enrico Tessitore ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Incidental Durotomy

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Cranial nerve palsies due to incidental durotomy in lumbar Spine surgery: a case report

British Journal of Neurosurgery ◽

10.1080/02688697.2018.1508642 ◽

2018 ◽

Vol 34 (6) ◽

pp. 599-601 ◽

Cited By ~ 1

Author(s):

Thea Overgaard Wichmann ◽

Sanja Karabegovic ◽

Mikkel Mylius Rasmussen

Keyword(s):

Case Report ◽

Lumbar Spine ◽

Spine Surgery ◽

Cranial Nerve ◽

Lumbar Spine Surgery ◽

Cranial Nerve Palsies ◽

Incidental Durotomy

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Incidental durotomy in lumbar spine surgery — is there still a role for flat bed rest?

The Spine Journal ◽

10.1016/j.spinee.2014.06.014 ◽

2014 ◽

Vol 14 (10) ◽

pp. 2522-2523 ◽

Cited By ~ 4

Author(s):

Oliver P. Gautschi ◽

Martin N. Stienen ◽

Nicolas R. Smoll ◽

Marco V. Corniola ◽

Karl Schaller

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Bed Rest ◽

Lumbar Spine Surgery ◽

Incidental Durotomy

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Incidental Durotomy During Lumbar Spine Surgery

Neurosurgery Quarterly ◽

10.1097/wnq.0b013e31824000ae ◽

2012 ◽

Vol 22 (2) ◽

pp. 105-112 ◽

Cited By ~ 6

Author(s):

Iraj Lotfinia ◽

Sima Sayyahmelli

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Incidental Durotomy

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Long-term impact of obesity on patient-reported outcomes and patient satisfaction after lumbar spine surgery: an observational study

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20592 ◽

2021 ◽

Vol 34 (1) ◽

pp. 73-82 ◽

Cited By ~ 1

Author(s):

Christine Park ◽

Alessandra N. Garcia ◽

Chad Cook ◽

Christopher I. Shaffrey ◽

Oren N. Gottfried

Keyword(s):

Patient Satisfaction ◽

Lumbar Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Normal Weight ◽

Lumbar Spine Surgery ◽

Morbidly Obese ◽

Lumbar Surgery ◽

Patient Reported

OBJECTIVEObese body habitus is a challenging issue to address in lumbar spine surgery. There is a lack of consensus on the long-term influence of BMI on patient-reported outcomes and satisfaction. This study aimed to examine the differences in patient-reported outcomes over the course of 12 and 24 months among BMI classifications of patients who underwent lumbar surgery.METHODSA search was performed using the Quality Outcomes Database (QOD) Spine Registry from 2012 to 2018 to identify patients who underwent lumbar surgery and had either a 12- or 24-month follow-up. Patients were categorized based on their BMI as normal weight (≤ 25 kg/m2), overweight (25–30 kg/m2), obese (30–40 kg/m2), and morbidly obese (> 40 kg/m2). Outcomes included the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for back pain (BP) and leg pain (LP), and patient satisfaction was measured at 12 and 24 months postoperatively.RESULTSA total of 31,765 patients were included. At both the 12- and 24-month follow-ups, those who were obese and morbidly obese had worse ODI, VAS-BP, and VAS-LP scores (all p < 0.01) and more frequently rated their satisfaction as “I am the same or worse than before treatment” (all p < 0.01) compared with those who were normal weight. Receiver operating characteristic curve analysis revealed that the BMI cutoffs for predicting worsening disability and surgery dissatisfaction were 30.1 kg/m2 and 29.9 kg/m2 for the 12- and 24-month follow-ups, respectively.CONCLUSIONSHigher BMI was associated with poorer patient-reported outcomes and satisfaction at both the 12- and 24-month follow-ups. BMI of 30 kg/m2 is the cutoff for predicting worse patient outcomes after lumbar surgery.

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