SPORT: Does incidental durotomy affect long-term outcomes in cases of spinal stenosis?

In a prospective cohort study from a randomized clinical trial database (SPORT) Atman Desai *et al.* from the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire published in the *Neurosurgery Journal* to assess whether incidental durotomy during first-time open decompressive laminectomy for lumbar spinal stenosis impacts long-term outcomes. Incidental durotomy was associated with longer operative times, greater blood loss, and longer hospital stays but did not impact long-term functional outcomes (up to 4 years) such as pain, physical function, or disability scores

This study leverages the robust SPORT dataset, focusing on a sub-cohort of 409 patients with lumbar spinal stenosis undergoing first-time laminectomy. The reported 9% incidence of durotomy aligns with existing literature. Its main strength lies in the long-term follow-up (mean 43.8 months) and standardized outcome measures, including SF-36 and ODI.

However, there are several concerns:

– Selection Bias: Despite prospective data collection, the analysis was retrospective, increasing the risk of bias.

– Confounding: While baseline characteristics were well-matched, unmeasured surgeon-related factors (e.g., skill, experience) could influence both durotomy occurrence and outcomes.

– Underpowered for Rare Events: With only 37 durotomy cases, the study may lack statistical power to detect subtle differences in outcomes or rare complications.

– Blinding: There is no mention of blinding in outcome assessments, a nontrivial issue when dealing with subjective measures such as patient-reported outcomes.

Takeaway for the Practicing Neurosurgeon:

Incidental durotomy, while increasing perioperative morbidity, does not necessarily translate to worse long-term outcomes—providing some reassurance in clinical practice. Nonetheless, its occurrence still warrants prevention efforts due to short-term burden.

Bottom Line:

Durotomy is not a prognostic determinant for long-term recovery following first-time laminectomy for stenosis.

Score: 6.5 / 10

Desai A, Ball PA, Bekelis K, Lurie J, Mirza SK, Tosteson TD, Weinstein JN. SPORT: Does incidental durotomy affect longterm outcomes in cases of spinal stenosis? Neurosurgery. 2015 Mar;76 Suppl 1(0 1):S57-63; discussion S63. doi: 10.1227/01.neu.0000462078.58454.f4. PMID: 25692369; PMCID: PMC4517439.