Complications necessitating a return to the operating room following intradural spine surgery

Objective: To determine the incidence of and risk factors for cerebrospinal fluid (CSF), wound, and hematoma-related complications following intradural spine surgery. Background: Complications of intradural spinal surgery requiring a return to the operating room lengthen hospital stay and increase cost as well as patient risk. Here we present our experience with complications in intradural spinal surgery. Methods: Between 1993 and 2010, a total of 528 pediatric and adult patients who underwent biopsy and/or resection of intramedullary or extramedullary spinal lesions at Mayo Clinic-Rochester were evaluated. Results: The overall complication rate in this series was 4.9%. Complications, such as neurologic worsening due to an etiology not able to be treated surgically, or medical complications, such as deep venous thrombosis, were not included in this study. The overall complication rates that were CSF-related, wound-related, hematoma-related, and miscellaneous were 3.0%, 1.1%, 0.6%, and 0.2% respectively. Complication rates decreased with age from 15.4% in 0- to 10-year-olds to 4.1% in 61- to 90-year-olds. Tumors represented the majority of pathology at 90.5%. The complication rate for patients who had prior treatment was higher at 6.9% compared with 4.7% in those who had no prior treatment (P = 0.5). Intramedullary tumors had a complication rate of 7.1% vs. 3.6% for extramedullary tumors (P = 0.14). Some patients (5.7%) had coexisting intracranial tumors at the time of their surgery but none had complications with intradural spine surgery. Conclusions: Complications of intradural spine surgery are most commonly CSF related, may decrease with increasing age of the patient, and are higher with intramedullary tumors.