Durotomies in Endoscopy: Impact on Surgical Outcomes Compared to Minimally Invasive Spine Surgery

Introduction: Minimally invasive tubular spine approaches (MIS) and endoscopic spine approaches (ES) are increasingly favored for treating lumbar stenosis and herniated discs due to quicker recovery and reduced postoperative pain. Despite these benefits, durotomies are a significant complication in modern minimally invasive techniques, challenging to repair through small incisions. This study compares durotomy incidence between MIS and ES, identifies associated risk factors, and evaluates their impact on patient outcomes.

Methods: We analyzed data from 181 patients who underwent MIS or ES for laminectomies or discectomies. Durotomy rates were compared between the two techniques, and risk factors predisposing patients to durotomy were identified through preoperative MRI analysis. Statistical analysis included SPSS, Pearson-Chi-Square tests, and Pearson correlation to assess outcomes influenced by durotomies.

Results: Among the patients, 80 underwent ES and 101 underwent MIS. Durotomy incidence did not significantly differ between ES and MIS (10.1% vs. 7.5%, p=0.572). However, within ES procedures, laminectomies showed a higher durotomy rate compared to discectomies (p=0.030). ES procedures at L3-L4 and involving foraminal discs were associated with increased durotomy rates (r=0.228, p=0.042; r=0.270, p=0.016), while no such correlation was observed in MIS. Older age and multiple discectomies performed via ES were also associated with higher durotomy rates (r=0.228, p=0.042; r=0.224, p=0.042). Durotomies in MIS were linked to longer operative times and hospital stays (r=0.270, p=0.006; r=0.293, p=0.003), whereas this association was not significant in ES.

Conclusion : This study reveals comparable durotomy rates between ES and MIS techniques. Subgroup analysis within ES demonstrated higher durotomy incidence with laminectomies at specific levels and the presence of foraminal discs. Interestingly, durotomies did not prolong operative times or hospital stays in ES compared to MIS. Identifying these risk factors preoperatively may optimize patient outcomes in minimally invasive spine surgeries.