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Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

机译：腰椎退化脊髓手术的意外丧失术：对文献的10年系统审查

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OBJECT Unintended durotomy is a common occurrence during lumbar spinal surgery, particularly in surgery for degenerative spinal conditions, with the reported incidence rate ranging from 0.3% to 35%. The authors performed a systematic literature review on unintended lumbar spine durotomy, specifically aiming to identify the incidence of durotomy during spinal surgery for lumbar degenerative conditions. In addition, the authors analyzed the incidence of durotomy when minimally invasive surgical approaches were used as compared with that following a traditional midline open approach. METHODS A MEDLINE search using the term “lumbar durotomy” (under the 2015 medical subject heading [MeSH] “cerebrospinal fluid leak”) was conducted on May 13, 2015, for English-language medical literature published in the period from January 1, 2005, to May 13, 2015. The resulting papers were categorized into 3 groups: 1) those that evaluated unintended durotomy rates during open-approach lumbar spinal surgery, 2) those that evaluated unintended durotomy rates during minimally invasive spine surgery (MISS), and 3) those that evaluated durotomy rates in comparable cohorts undergoing MISS versus open-approach lumbar procedures for similar lumbar pathology. RESULTS The MEDLINE search yielded 116 results. A review of titles produced 22 potentially relevant studies that described open surgical procedures. After a thorough review of individual papers, 19 studies (comprising 15,965 patients) pertaining to durotomy rates during open-approach lumbar surgery were included for analysis. Using the Oxford Centre for Evidence-Based Medicine (CEBM) ranking criteria, there were 7 Level 3 prospective studies and 12 Level 4 retrospective studies. In addition, the authors also included 6 studies (with a total of 1334 patients) that detailed rates of durotomy during minimally invasive surgery for lumbar degenerative disease. In the MISS analysis, there were 2 prospective and 4 retrospective studies. Finally, the authors included 5 studies (with a total of 1364 patients) that directly compared durotomy rates during open-approach versus minimally invasive procedures. Studies of open-approach surgery for lumbar degenerative disease reported a total of 1031 durotomies across all procedures, for an overall durotomy rate of 8.11% (range 2%-20%). Prospectively designed studies reported a higher rate of durotomy than retrospective studies (9.57% vs 4.32%, p = 0.05). Selected MISS studies reported a total of 93 durotomies for a combined durotomy rate of 6.78%. In studies of matched cohorts comparing open-approach surgery with MISS, the durotomy rates were 7.20% (34 durotomies) and 7.02% (68), respectively, which were not significantly different. CONCLUSIONS Spinal surgery for lumbar degenerative disease carries a significant rate of unintended durotomy, regardless of the surgical approach selected by the surgeon. Interpretation of unintended durotomy rates for lumbar surgery is limited by a lack of prospective and cohort-matched controlled studies.
机译：对象意外的杜伦确患者是腰椎手术期间的常见发生，特别是在退行性脊柱条件下的手术中，报告的发病率范围为0.3％至35％。作者对非目的的腰椎血管囊肿进行了系统的文献综述，特别是旨在鉴定腰椎手术期间患者患者患者的肺部手术中的发生率。此外，当使用传统的中线开放方法后，使用当使用微创手术方法时，分析了杜伦蒂的发生率。方法使用术语“腰杜孔术”（在2015年的2015年医学主题[Mesh]“脑脊液泄漏下）于2005年1月1日发表的英语医学文献进行了Medline搜索，到2015年5月13日。将所得纸张分为3组：1）在开放方法腰椎手术期间评估意外的杜疏术率的人，2）在微创脊柱外科（Miss）期间评估意外的杜疏术率的人，以及3）那些评估了与类似腰椎病理学的比较队列的比较队列中的跨疏膜率的速率。结果Medline搜索产生116个结果。对标题产生的审查产生了22项潜在的相关研究，描述了开放的外科手术。在彻底审查单个论文后，包括在开放方法腰部手术期间与杜疏香术率有关的19项研究（包含15,965名患者）进行分析。使用牛津中心进行循证医学（CEBM）排名标准，有7级的3级前瞻性研究和12级的4级回顾性研究。此外，作者还包括6项研究（共有1334名患者），腰椎退行性疾病微创手术期间的杜伦蒂的详细差异。在小姐分析中，有2个前瞻性和4项回顾性研究。最后，作者包括5项研究（共1364名患者），在开放方法与微创手术期间直接比较了杜伦蒂率。腰椎退行性疾病的开放方法手术研究报告总共1031个胁迫术，总体率为8.11％（范围2％-20％）。前瞻性设计的研究报告了比回顾性研究更高的杜疏膜（9.57％Vs 4.32％，P = 0.05）。选定的未命中研究报告总共93个杜孔，持续的跨膜延长率为6.78％。在对比较开放方法手术的匹配队列的研究中，杜疏术率分别为7.20％（34℃）和7.02％（68），其没有显着差异。结论腰椎术后疾病的脊柱手术均有巨大的意外致孔术，无论外科医生选择的手术方法如何。对腰部手术的意外杜孔率的解释受到缺乏预期和队列匹配的对照研究的限制。

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