lumbar_discectomy_complications

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 ===== Outcomes after incidental durotomy during first-time lumbar discectomy ===== ===== Outcomes after incidental durotomy during first-time lumbar discectomy =====
  
-**Type of Study:** Prospective multicenter cohort study (SPORT database)   +In a prospective multicenter cohort study (SPORT database)   
-**Authors:** Atman Desai et al.   +Atman Desai et al.   
-**Affiliations:** Dartmouth-Hitchcock Medical Center, Lebanon   +from the Dartmouth-Hitchcock Medical Center, Lebanon   
-**Journal:** Journal of Neurosurgery: Spine   +published in the Journal of Neurosurgery: Spine   
-**Purpose:** To determine whether incidental durotomy during first-time lumbar discectomy affects long-term clinical outcomes. +to determine whether incidental durotomy during first-time lumbar discectomy affects long-term clinical outcomes. 
- +Among 799 patients undergoing first-time lumbar discectomy, 25 (3.1%) experienced incidental durotomy. These patients had longer operative time, increased blood loss, and longer hospital stays, but no statistically significant differences in long-term outcomes, including pain scores, disability indices, or rates of additional surgery 
-**Conclusions:** Among 799 patients undergoing first-time lumbar discectomy, 25 (3.1%) experienced incidental durotomy. These patients had longer operative time, increased blood loss, and longer hospital stays, but no statistically significant differences in long-term outcomes, including pain scores, disability indices, or rates of additional surgery.+((Desai A, Ball PA, Bekelis K, Lurie JD, Mirza SK, Tosteson TD, Weinstein JN. Outcomes after incidental durotomy during first-time lumbar discectomy. J Neurosurg Spine. 2011 May;14(5):647-53. doi: 10.3171/2011.1.SPINE10426. Epub 2011 Mar 4. PMID: 21375385; PMCID: PMC4517441.)).
  
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 **Review:**   **Review:**  
 This study leverages the robust SPORT dataset, providing a rare window into the real-world implications of incidental durotomy in lumbar discectomy. The multicenter nature and long follow-up (mean ~41 months) enhance external validity. However, key weaknesses diminish the impact: This study leverages the robust SPORT dataset, providing a rare window into the real-world implications of incidental durotomy in lumbar discectomy. The multicenter nature and long follow-up (mean ~41 months) enhance external validity. However, key weaknesses diminish the impact:
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 While the finding that incidental durotomy does not influence long-term outcomes is reassuring, the study falls short in guiding perioperative management. The implication that increased operative time and LOS are the only sequelae may mislead less experienced surgeons into underestimating the importance of careful durotomy repair and postoperative care. While the finding that incidental durotomy does not influence long-term outcomes is reassuring, the study falls short in guiding perioperative management. The implication that increased operative time and LOS are the only sequelae may mislead less experienced surgeons into underestimating the importance of careful durotomy repair and postoperative care.
  
-**Final Verdict:** This is a moderately informative observational study with limitations in power and granularity. Useful for broad reassurance but not practice-changing.+**Final Verdict:** This is a moderately informative observational study with limitations in power and granularity. Useful for broad reassurance but not [[practice-changing]]. 
 + 
 +**Takeaway for the Practicing Neurosurgeon:**  
 + 
 +Incidental durotomy in first-time discectomy does not compromise long-term outcomes but should still be meticulously managed given perioperative risks.
  
-**Takeaway for the Practicing Neurosurgeon:** Incidental durotomy in first-time discectomy does not compromise long-term outcomes but should still be meticulously managed given perioperative risks.+**Bottom Line:** 
  
-**Bottom Line:** Small durotomy incidence; no long-term outcome penalty, but study lacks detail to inform intraoperative and postoperative management.+Small durotomy incidence; no long-term outcome penalty, but study lacks detail to inform intraoperative and postoperative management.
  
 **Rating:** 5.5 / 10 **Rating:** 5.5 / 10
  
-**Title:** Outcomes after incidental durotomy during first-time lumbar discectomy   
-**Citation:** Desai A, Ball PA, Bekelis K, et al. *J Neurosurg Spine.* 2011 May;14(5):647-653. doi:10.3171/2011.1.SPINE10426. Epub 2011 Mar 4.   
 **Publication Date:** March 4, 2011   **Publication Date:** March 4, 2011  
-**Corresponding Author Email:** atman.desai@hitchcock.org+**Corresponding Author Email:** [[atman.desai@hitchcock.org]]
  
 **Blog Categories:** Lumbar Spine, Dural Injury, Surgical Complications   **Blog Categories:** Lumbar Spine, Dural Injury, Surgical Complications  
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