Incidental Durotomies do not Impact Long-term Neurologic Function After Adult Spinal Deformity Surgery

Study Design. – Retrospective review of multicenter data. Objective. – To compare long-term neurologic recovery in patients with and without incidental durotomy (hereafter, “durotomy”) after adult spinal deformity surgery. Summary of Background Data. – Durotomy is a common complication of adult spinal deformity surgery and is typically associated with technical challenges during the procedure. Methods. – Using a prospectively collected database, we included 1452 patients (73% female; mean age, 60±14 y) who underwent adult spinal deformity surgery from 2008–2020 at 22 US centers. We compared patients with and without durotomy with respect to demographic characteristics, surgical variables, and neurologic outcomes at baseline and at 1 and 2 years postoperatively. Multivariate analysis compared neurologic complications and length of stay (LOS) between the groups. P<.05 was considered significant. Results. – Durotomy occurred in 121 patients (8.3%). Patients with durotomy were more likely to have undergone revision surgery (P<.001) and had higher Charlson Comorbidity Index values (P=.029) than those who did not. Patients with durotomy had higher estimated blood loss, longer operative time, more frequent 3-column osteotomies, and longer LOS (all, P<.001). Lower-extremity motor scores did not differ between patients with durotomy and those without at 1 and 2 years postoperatively. The incidence of neurologic, medical, and surgical complications did not differ significantly between the 2 groups. Patients with durotomy had a higher rate of inpatient return to the operating room (5.0%) than those without (2.0%) (P=.04). On multivariate analysis, there were no differences between groups in lower-extremity motor scores, neurologic complications, or LOS. Conclusions. – Incidental durotomy during adult spinal deformity surgery was associated with greater intraoperative complexity and transient sensory symptoms but did not adversely affect long-term motor recovery, neurologic complications, or patient-reported outcomes. These findings suggest durotomy is a manageable complication without lasting functional consequences.