#164 Risk Factors for Dural Tears: A Study of Elective Spine Surgery
Value and Outcomes in Spine Surgery
Poster Presented by: D. Shepherd
D. Shepherd (1)
M. Murphy (1)
P. Kerezoudis (1)
P. Maloney (1)
B. Mccutcheon (1)
L. Rinaldo (1)
D. Ubl (2)
E. Habermann (2)
W. Krauss (1)
M. Bydon (1)
(1) Mayo Clinic, Department of Neurosurgery, Rochester, MN, United States
(2) Mayo Clinic, Rochester, MN, United States
Introduction: Dural tears are known complication in elective spine surgery. The majority of prior studies focused on smaller cohorts from single institutions with homogenous patient populations, and these studies identified increased patient age, degenerative pathologies, and revision surgery as risk factors for dural tears. This study moves beyond previous cohort studies and benchmark data by studying a generalizable population of elective spine surgery from a multicenter registry in an effort to validate, disprove, and/or identify novel risk factors for dural tears.
Methods: A retrospective cohort analysis queried a multicenter registry for patients with degenerative spinal diagnoses undergoing elective spinal surgery from 2010-2014. Multivariable logistic regression analysis interrogated for independent risk factors of dural tears.
Results: Of 104,930 patients undergoing elective spine surgery, a dural tear requiring repair occurred in 0.6% of cases. On adjusted analysis the following factors were independently associated with increased likelihood of a dural tear: ankylosing spondylitis vs. intervertebral disc disorders (OR 4.6, 95% CI: 1.1-19.4), greater than two levels (2-4 levels OR 1.8, 95% CI: 1.5-2.3 and 5+ levels OR 1.9, 95% CI: 1.4-2.5 vs. single level), combined surgical approach (OR 3.6, 95% CI: 1.9-6.5) and posterior approach (OR 8.0, 95% CI: 5.0-12.9) vs. anterior approach, decompression only vs. fusion and decompression (OR 1.3, 95% CI 1.0-1.6), age groups 85+ (OR 2.3, 95% CI: 1.4-3.5), 75-84 (OR 1.5, 95% CI: 1.2-1.9), and 65-74 (OR 1.4, 95% CI: 1.1-1.7) vs. < 65, obesity (BMI ≥30) (OR 1.2, 95% CI: 1.0-1.4), corticosteroid use(OR 1.5 95% CI: 1.1-2.1), and preoperative platelet count < 150 (OR 1.4 95% CI: 1.0-1.9). African American race was associated with a decreased likelihood of a dural tear compared to Non-Hispanic White (OR 0.6, 95% CI: 0.4-0.8).
Conclusions: This large, multicenter study identifies several novel risk factors for dural tears in the elective spine surgery population, including corticosteroid use, thrombocytopenia, and ankylosing spondylitis. The results of this analysis provide further information for surgeons to use both in operative planning and in preoperative counseling when discussing the risk of dural tears.