• Ram Alluri, H Paco Kang, Gabriel Bouz, Jeffrey Wang, and Raymond J Hah.
• Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.
• Spine. 2020 Feb 1; 45 (3): E155-E162.

Study DesignRetrospective database analysis.ObjectiveThe aim of this study was to match risk factors for complications in patients who did and did not sustain a dural tear while undergoing posterior lumbar spine surgery and compare local and systemic complications.Summary Of Background DataCurrent data do not adequately define whether the event of sustaining an isolated dural tear increases the risk for postoperative complications while controlling for other confounding risk factors.MethodsThe PearlDiver Database was queried for patients who underwent posterior lumbar spine decompression and/or fusion for degenerative pathology. Patients with and without dural tears were 1:2 matched based on demographic variables and comorbidities. Complications, cost, length of stay (LOS), and readmission rates were analyzed.ResultsThe 1:2 matched cohort included 9038 patients with a dural tear and 17,340 patients without a dural tear. All complications assessed were significantly higher in the dural tear group (P < 0.03). Venothromboembolic (VTE) events occurred in 1.3% of patients with a dural tear and 0.9% of patients without a dural tear (odds ratio [OR] 1.46, P < 0.0001). Meningitis occurred in 25 patients (0.3%) with a dural tear and eight patients (<0.1%) without a dural tear (OR 6.0, P < 0.0001). Patients with a dural tear had 120% higher medical costs, 200% greater LOS, and were two times more likely to be readmitted (P < 0.0001).ConclusionSustaining a dural tear while undergoing posterior lumbar spinal decompression and/or fusion for degenerative pathology significantly increased the risk of complications and increased length of stay, risk of readmission, and overall 90-day hospital cost. Dural tears specifically increased the risk of a VTE complication by 1.46 times and meningitis by six times; these are important complications to have a high degree of suspicion for in the setting of durotomy, as they can lead to significant morbidity for the patient.Level Of Evidence3.

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