Incidental Durotomies do not Impact Long-term Neurologic Function After Adult Spinal Deformity Surgery

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Durotomy is a frequent complication in adult spinal deformity surgery, often linked to procedural difficulties.
• Understanding the long-term effects of incidental durotomy is crucial for patient management.

Purpose of the Study:

• To compare long-term neurologic recovery in patients who experienced incidental durotomy versus those who did not, following adult spinal deformity surgery.

Main Methods:

• Retrospective review of multicenter data from 1452 patients undergoing adult spinal deformity surgery (2008-2020).
• Comparison of demographic, surgical variables, and neurologic outcomes at baseline and 1-2 years postoperatively between patients with and without durotomy.
• Multivariate analysis assessed neurologic complications and length of stay (LOS).

Main Results:

• Durotomy occurred in 8.3% of patients and was associated with revision surgery and higher comorbidity index.
• Patients with durotomy had increased operative time, blood loss, 3-column osteotomies, and LOS.
• No significant differences in lower-extremity motor scores or overall neurologic complications were observed at 1-2 years postoperatively.

Conclusions:

• Incidental durotomy in adult spinal deformity surgery is linked to increased intraoperative complexity and temporary sensory issues.
• Long-term motor recovery, neurologic complications, and patient-reported outcomes are not adversely affected by durotomy.
• Durotomy is a manageable complication without persistent functional consequences.