Obese patients have an increased rate of incidental durotomy in lumbar spine surgery

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A published-ahead-of-print study in the journal Spine has discovered a link between incidental durotomy in lumbar spine surgery and obesity.

The retrospective database analysis, led by Christopher A Burks, Baylor College of Medicine, USA, compared body mass index and procedural codes with documentation of incidental durotomy during surgery for decompression and/or fusion. Odds ratios and 95% confidence intervals were calculated and chi square test was used to assess for statistical significance. The authors decided to undertake the study on account of the “paucity of data on the overall impact of obesity on the rate of incidental durotomy in lumbar spine surgery specifically with regard to the type of procedure performed.

The authors write that “incidental durotomy ranged from 0.5–2.6%”, with the highest rates observed in multilevel laminectomies and revision decompressions in the obese and morbidly obese groups. For patients who underwent decompression-only procedures as well as fusion with or without decompression, there was a significantly increased rate of durotomy in obese and morbidly obese patients compared to non-obese patients. Furthermore, Burks and colleagues note that the morbidly obese cohort also had significantly higher rates of incidental durotomy than the non-obese cohort in both revision decompression and revision fusion procedures.

Given these results, the study concludes that “obesity, in association with increasing complexity of the procedure, increases the rate of incidental durotomy in lumbar spine surgery.” Burk et al. also comment that the trend of growing rates of obesity in the wider population means that the risks of incidental durotomy will increase as time goes on, as will other obesity-related surgical complications.