A Prospective Study of the Accidental Durotomies in Microendoscopic Lumbar Spine Decompression Surgeries. Incidence, Surgical Outcomes, Postoperative Patient Mobilization Protocol

Abstract

Objective To study the incidence, risk factors, surgical outcomes of accidental durotomies (ADT) in patients of microendoscopic lumbar decompression surgeries (MLDS) and the postoperative patient mobilization protocol. Methods A total of 550 patients who underwent MLDS from January 2012 to march 2020 under single surgeon and single institute were included in the study and incidence of ADT risk factors like age, BMI, smoking status, diabetes mellitus, surgeon’s experience were studied for the same and early mobilization protocol for all the patients was followed. Results Age >60 years (p=0.0062), bilateral decompression with unilateral approach, surgeons experience in the first 3 years over next 5 years (p=0.037) were the statistically significant risk factors for increased incidence of ADT. Most of the ADT were small which did not require primary repair and managed with sealants like gelfoam and fibrin glue. Postoperative recovery in JOA and ODI scores in both ADT and non ADT cohorts were same. Conclusion MISS has low incidence of ADT and age >60 years and surgical technique of bilateral decompression with unilateral approach and surgeons expertise are the significant risk factors. MISS also has less risk of CSF leak symptoms and pseudomeningocele formation because of limited dead space formation in the soft tissue which helps in early postoperative mobilization and reduces the duration of hospital stay.

Keywords

• accidental durotomy
• microendoscopic disectomy
• gelfoam
• cerebrospinal fluid leak
• surgeons experience