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首页> 外文期刊>Neurosurgical focus >Management of incidental durotomy in minimally invasive spine surgery
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Management of incidental durotomy in minimally invasive spine surgery

机译：微创脊柱手术中偶然性硬膜切开的处理

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Object. Unintended durotomy is one of the most common complications in spine surgery that may lead to serious complications if not recognized or treated properly. There are few reports on the management of durotomies incurred during minimally invasive spine surgery (MISS). The authors describe their experience in a series of consecutive MISS patients with unintended durotomies. Methods. All patients who underwent MISS by the senior author between August 2006 and February 2011 were retrospectively reviewed, and cases with unintended durotomies were identified. A case-control study was carried out comparing patient demographics and perioperative data between patients with and without durotomy. Surgical technique, including a proposed algorithm for management of durotomies, is described. Results. Unintended durotomy occurred in 53 (9.4%) of 563 patients. The mean age at surgery was 60.7 years (range 30-85 years). Previous surgery at the same level was performed in 5 patients (9.4%). Two patients underwent posterior cervical surgery, and 51 patients underwent posterior lumbar surgery. Decompression alone was performed in 32 patients (60.4%), and fusion was performed in 21 patients (39.6%). The mean operative time was 105 minutes in the decompression group and 310 minutes in the fusion group (p < 0.001). Estimated blood loss was 60 ml in the decompression group and 381 ml in the fusion group (p < 0.001). The hospital length of stay was 52 hours in the decompression group and 106 hours in the fusion group (p < 0.001). The mean follow-up was 310 days, and there were no cases of cutaneous CSF fistula, pseudomeningocele, or other complications referable to durotomy in either group. Risk factors identified for durotomy included previous operation at the same level (p = 0.019) and operation in the lumbar spine region (p = 0.001). Conclusions. In the authors' consecutive series of patients undergoing MISS, an unintended durotomy was associated with fewer complications than previously reported for open spinal surgery. The authors propose a simple management algorithm that includes early mobilization and results in excellent clinical outcomes with no incidence of postoperative cutaneous CSF fistula or other complications.
机译：目的。意外的硬膜切开术是脊柱外科手术中最常见的并发症之一，如果不能正确识别或治疗，可能会导致严重的并发症。关于微创脊柱外科手术（MISS）发生的切开处理的报道很少。作者描述了他们在一系列连续的MISS患者中意外手术的经验。方法。回顾性分析了2006年8月至2011年2月间由资深作者进行的MISS治疗的所有患者，并确定了意外切开的病例。进行了一项病例对照研究，比较了有或没有硬膜切开术患者的患者人口统计学和围手术期数据。描述了外科技术，包括提出的用于切开术的管理算法。结果。 563例患者中有53例发生了意外的硬膜切开术（9.4％）。手术的平均年龄为60.7岁（范围30-85岁）。 5名患者（9.4％）进行了相同水平的既往手术。 2例接受了颈椎后路手术，51例接受了腰椎后路手术。仅减压治疗32例（60.4％），融合治疗21例（39.6％）。减压组的平均手术时间为105分钟，融合组的平均手术时间为310分钟（p <0.001）。减压组估计失血量为60 ml，融合组估计失血量为381 ml（p <0.001）。减压组住院时间为52小时，融合组为106小时（p <0.001）。平均随访时间为310天，两组均无CSF皮肤瘘，假性脑膜膨出或其他与硬膜切开有关的并发症。确定硬膜切开术的危险因素包括先前在相同水平进行手术（p = 0.019）和在腰椎区域进行手术（p = 0.001）。结论在作者连续进行的MISS患者系列研究中，与先前报道的开放性脊柱外科手术相比，意外的硬膜切开术与较少的并发症相关。作者提出了一种简单的管理算法，该算法包括早期动员，并具有出色的临床效果，且无术后皮肤CSF瘘管或其他并发症的发生。

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