Evaluate if dural tears (DT) are an indirect risk factor for venous thromboembolic disease through increased recumbency in patients undergoing elective lumbar decompression and instrumented fusion.
A retrospective cohort study of consecutive patients undergoing elective lumbar decompression and instrumented fusion at a single institution between 2016 and 2019. Patients were divided into cohorts: those who sustained a dural tear and those who did not. The cohorts were compared using t-test or Wilcoxon rank-sum for continuous variables and Fisher’s exact or chi-squared test for nominal variables.
611 patients met inclusion criteria. 144 patients (23.6%) sustained a DT. The DT cohort tended to be older (63.6 vs 60.6 years, p=0.0052) and have more comorbidities (CCI 2.75 vs 2.35, p=0.0056). There was no significant difference in the rate of symptomatic deep vein thrombosis (2.1% vs 2.6%, p=1.0) or pulmonary embolus (1.4% vs 1.50%, p=1.0). Intraoperatively, DT was associated with increased blood loss (754mL vs 512mL, p<0.0001), operative time (224 vs 195 minutes, p<0.0001), and rate of transfusion (19.4% vs 9.4%, p=0.0018). Postoperatively, DT was associated with increased time to ambulation (2.6 vs 1.4 days, p<0.0001), length of stay (5.8 vs 4.0 days, p<0.0001), and rate of discharge to rehab (38.9 vs 25.3%, p=0.0021).
While dural tears during elective lumbar decompression and instrumentation led to later ambulation and longer hospital stays, the increased recumbency did not significantly increase the rate of symptomatic venous thromboembolic disease.
dural tear; durotomy; lumbar spine; perioperative complications; venous thromboembolic disease.