Incidental Durotomy During Transforaminal Lumbar Interbody Fusion (TLIF) Surgery with Expandable Interbody Spacers: A Retrospective, Single-Center Analysis of Complications and Outcomes.

Abstract

Study DesignRetrospective cohort study.ObjectivesTo evaluate the frequency, risk factors, and impact of incidental durotomy on adverse events and outcomes after TLIF with expandable interbody spacers.MethodsWe reviewed 433 consecutive patients treated by TLIF using expandable titanium interbody implants (ALTERA®, Globus Medical Inc) on 538 levels between December 2018 and September 2023. Patients with incidental durotomy (ID) and cerebrospinal fluid leakage were compared to patients without ID, focusing on patient-specific and surgery-related factors, adverse events, clinical outcomes (MacNab criteria), and radiological outcomes at discharge, 3, and 12 months.ResultsThe ID rate was 9.0% (39/433 patients). Patients with ID had lower BMI (26.1 ± 5.2 vs 28.0 ± 5.3 kg/m², P = .03), longer surgery duration (358 ± 132 vs 305 ± 128 minutes, P = .01), and extended hospital stays (14.7 ± 12.8 vs 10.9 ± 8.2 days, P < .01). More postoperative adverse events (51.3% vs 28.7%, P = .004) with higher severity (28.2% vs 13.2% moderate to severe, P = .019) occurred at discharge. No differences were found in outcomes at 3 or 12 months. ID patients showed higher risks for impaired wound healing (adjusted OR, 4.39; 95% CI, 1.90-10.2; P = .001) and pulmonary embolism (adjusted OR, 3.52; 95% CI, 1.13-10.9; P = .029).ConclusionsIncidental durotomy was associated with longer surgery time, hospital stays, and increased early postoperative complications. While not affecting mid-to-long-term outcomes, ID increased risks for wound healing difficulties and pulmonary embolisms.