Impact of incidental dural tears on postoperative outcomes in patients undergoing cervical spine surgery: a multicenter retrospective cohort study

Yasushi Oshima; Hideki Nakamoto; Toru Doi; Junya Miyahara; Yusuke Sato; Juichi Tonosu; Naohiro Tachibana; Daiki Urayama; Fumiko Saiki; Masato Anno; Naoki Okamoto; Katsuyuki Sasaki; Shima Hirai; Masahito Oshina; Shurei Sugita; Kazuhiro Masuda; Sakae Tanaka

doi:10.1016/j.spinee.2024.09.020

Impact of incidental dural tears on postoperative outcomes in patients undergoing cervical spine surgery: a multicenter retrospective cohort study

Spine J. 2024 Sep 26:S1529-9430(24)01033-7. doi: 10.1016/j.spinee.2024.09.020. Online ahead of print.

Authors

Yasushi Oshima¹, Hideki Nakamoto², Toru Doi², Junya Miyahara², Yusuke Sato³, Juichi Tonosu⁴, Naohiro Tachibana⁵, Daiki Urayama⁶, Fumiko Saiki⁷, Masato Anno⁸, Naoki Okamoto⁹, Katsuyuki Sasaki¹⁰, Shima Hirai¹¹, Masahito Oshina¹², Shurei Sugita¹³, Kazuhiro Masuda¹⁴, Sakae Tanaka¹⁵

Affiliations

¹ Department of Orthopaedic Surgery, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan. Electronic address: yoo-tky@g.ecc.u-tokyo.ac.jp.
² Department of Orthopaedic Surgery, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.
³ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 150-8935, 4-1-2, Hiroo, Shibuya, Tokyo, Japan.
⁴ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, 221-0021, 1-1 Kidukisumiyoshicho, Nakahara, Kawasaki, Kanagawa, Japan.
⁵ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, 180-0023, 1-26-1, Sakaiminami, Musashino, Tokyo, Japan.
⁶ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, 162-8543, 5-1 Tsukutocho, Shinjuku, Tokyo, Japan.
⁷ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 222-0036, Kodukuecho, Kohoku, Yokohama, Kanagawa, Japan.
⁸ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Spine Center, Toranomon Hospital, 105-8470, 2-2-2 Toranomon, Minato, Tokyo, Japan.
⁹ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Saitama Hospital, 330-0081, 1-5 Shintoshin, Chuho, Saitama, Saitama, Japan.
¹⁰ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Orthopedic Surgery, Inanami Spine and Joint Hospital, 140-0002, 3-17-5, Higashishinagawa, Shinagawa, Tokyo, Japan.
¹¹ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Orthopedic Surgery, Sagamihara National Hospital, 252-0392, 18-1, Sakuradai, Minami, Sagamihara, Kanagawa, Japan.
¹² University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Spine Center, NTT Medical Center Tokyo, 141-8625, 5-9-1, Higashigotanda, Shinagawa, Tokyo, Japan.
¹³ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 113-0021, 3-18 Honkomagome, Bunkyo, Tokyo, Japan.
¹⁴ University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center, 183-8524, 2-8-29 Musashidai, Fuchu, Tokyo, Japan.
¹⁵ Department of Orthopaedic Surgery, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.

PMID: 39332684
DOI: 10.1016/j.spinee.2024.09.020

Abstract

Background context: Incidental dural tear (DT) during cervical spine surgery is a feared complication. However, its impact on patient-reported outcomes (PROs) remains unclear.

Purpose: To determine the influence of DTs on PROs 1 year after cervical spine surgery.

Study design: Retrospective cohort.

Patient sample: Patients undergoing elective cervical spine surgery for cervical spondylosis, ossification of the posterior longitudinal ligament (OPLL), and cervical disc herniation.

Outcome measures: Analysis included patients' characteristics, perioperative complications, and PROs both preoperatively and at 1 year postoperatively.

Methods: This study enrolled consecutive patients who underwent elective cervical spine surgery at 13 high-volume spine centers. All patients were required to complete questionnaires both preoperatively and 1 year postoperatively, which included PROs such as numerical rating scales of pain or dysesthesia for each part of the body, Neck Disability Index NDI, and Core Outcome Measures Index. Patients were divided into 2 groups based on the presence (DT+) or absence (DT-) of dural injury. Comparisons were made regarding patient background, perioperative complications, and pre and postoperative PROs. Propensity score matching was also utilized to adjust for patient background, and further comparisons were made regarding complication rates and PROs.

Results: Out of 2,704 patients, dural tears were identified in 97 (3.6%) cases. The DT+ group had a significantly higher proportion of fixation surgeries, upper cervical surgeries, OPLL, and revision surgeries. Perioperative complications were significantly higher in the DT+ group, including intraoperative nerve damage, postoperative paralysis, surgical site infections (SSI), and cerebrovascular complications. Outcomes collected from 2,163 patients (79.9%) revealed significantly more severe neck and upper limb pain in the DT+ group. After propensity score matching, significant differences persisted in postoperative paralysis and SSI in the DT+ group, but no significant differences were observed in PROs.

Conclusions: Patients with dural tears showed nearly equivalent postoperative outcomes at 1 year following cervical spine surgery compared to those without dural tears. However, the incidence of perioperative complications was higher, emphasizing the need for careful management.

Keywords: CSF leak; Cerebellar hemorrhage; Cervical spondylotic myelopathy; Complication; Incidental durotomy; Ossification of the posterior longitudinal ligament; Patient-reported outcome.