Management of incidental durotomies in an integrated Orthopaedic and Neurosurgical Spinal Unit
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- dc.contributor.author Rodríguez Rubio, David
- dc.contributor.author Amin, U.
- dc.contributor.author Bartolomé, D.
- dc.contributor.author Pont Acuña, Àngels
- dc.contributor.author Arco Churruca, Alejandro del
- dc.contributor.author Saló Bru, Guillem
- dc.contributor.author Vilá, G.
- dc.contributor.author Isart Torruella, Anna
- dc.contributor.author Manzano Espinosa, Dulce
- dc.contributor.author Lafuente Baraza, Jesus
- dc.date.accessioned 2024-10-07T06:28:03Z
- dc.date.available 2024-10-07T06:28:03Z
- dc.date.issued 2023
- dc.description.abstract Introduction: Incidental durotomy (ID) is an intraoperative event associated to prolonged bed rest and hospital stay, antibiotic use, higher patient dissatisfaction, and leg pain among other complications of its postoperative course. Several repair techniques and postsurgical care have been proposed for its management. This study was designed to develop an agreed protocol in cases of ID among Orthopaedic Surgeons (OS) and Neurosurgeons (NS) integrated into a Spinal Surgery Unit. Research question: Incidental durotomies management protocol. Materials and methods: From 997 eligible cases operated in Hospital del Mar (Barcelona, Spain) from April 2018 to March 2022, demographic, clinical, surgical and postoperative data was collected for statistical analysis from the morbidity and mortality database, with 79 identified IDs. Redo procedures were significantly associated to OS, and cervical and anterior/lateral approaches to NS, both groups were not comparable. Results: ID occurred in 7.9% of cases, more frequently after the lockdown (p=0.03), in females (p=0.04), during posterior approaches (p=0.003), and less frequently in the cervical spine (p=0.009). IDs were linked to postoperative infections (p< 0.001) and nerve root damage (p< 0.001). Patients without ID evolved more satisfactorily during the postoperative period (p=0.002), and those with CSF leak (20/79) spent on bed rest more than twice the time as those without (p<0.001). Multivariable logistic regression showed strong association between posterior approaches and ID, between complicated postoperative courses and ID. Discussion and conclusions: ID is linked to an adverse postoperative recovery, and it should be primarily repaired under microscope, with early mobilization of patients after surgery.
- dc.format.mimetype application/pdf
- dc.identifier.citation Rodríguez D, Amin U, Bartolomé D, Pont A, Del Arco A, Saló G, et al. Management of incidental durotomies in an integrated Orthopaedic and Neurosurgical Spinal Unit. Brain Spine. 2023 Oct 8;3:102682. DOI: 10.1016/j.bas.2023.102682
- dc.identifier.doi http://dx.doi.org/10.1016/j.bas.2023.102682
- dc.identifier.issn 2772-5294
- dc.identifier.uri http://hdl.handle.net/10230/61323
- dc.language.iso eng
- dc.publisher Elsevier
- dc.relation.ispartof Brain Spine. 2023 Oct 8;3:102682
- dc.rights © 2023 The Authors. Published by Elsevier B.V. on behalf of EUROSPINE, the Spine Society of Europe, EANS, the European Association of Neurosurgical Societies. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
- dc.subject.keyword Incidental durotomy
- dc.subject.keyword Management
- dc.subject.keyword Spinal surgery
- dc.title Management of incidental durotomies in an integrated Orthopaedic and Neurosurgical Spinal Unit
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion