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 see [[Accidental durotomy]].
-===== 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
-((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.))
-==== Critical Review ====
-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.
-==== Final Verdict ====
-**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
-===== Citation =====
-**Published:** March 2015
-===== Categories =====
-[[Category:Spine]] [[Category:Clinical Trials]] [[Category:Lumbar Stenosis]] [[Category:Complications]]
-===== Tags =====
-durotomy, SPORT trial, lumbar laminectomy, spinal stenosis, outcomes, complication, spine surgery, long-term follow-up