University of Virginia Medical Center, Charlottesville, Virginia 22908, USA.
Neurosurgery. 2011 Jan;68(1):117-23; discussion 123-4. doi: 10.1227/NEU.0b013e3181fcf14e.
Unintended durotomy is a common complication of spinal surgery. However, the incidences reported in the literature vary widely and are based primarily on relatively small case numbers from a single surgeon or institution.
To provide spine surgeons with a reliable incidence of unintended durotomy in spinal surgery and to assess various factors that may influence the risk of durotomy.
We assessed 108,478 surgical cases prospectively submitted by members of the Scoliosis Research Society to a deidentified database from 2004 to 2007.
Unintended durotomy occurred in 1.6% (1745 of 108 478) of all cases. The incidence of unintended durotomy ranged from 1.1% to 1.9% on the basis of preoperative diagnosis, with the highest incidence among patients treated for kyphosis (1.9%) or spondylolisthesis (1.9%) and the lowest incidence among patients treated for scoliosis (1.1%). The most common indication for spine surgery was degenerative spinal disorder, and among these patients, there was a lower incidence of durotomy for cervical (1.0%) vs thoracic (2.2%; P = .01) or lumbar (2.1%, P < .001) cases. Scoliosis procedures were further characterized by etiology, with the highest incidence of durotomy in the degenerative subgroup (2.2% vs 1.1%; P < .001). Durotomy was more common in revision compared with primary surgery (2.2% vs 1.5%; P < .001) and was significantly more common among elderly (> 80 years of age) patients (2.2% vs 1.6%; P = .006). There was a significant association between unintended durotomy and development of a new neurological deficit (P < .001).
Unintended durotomy occurred in at least 1.6% of spinal surgeries, even among experienced surgeons. Our data provide general benchmarks of durotomy rates and serve as a basis for ongoing efforts to improve safety of care.
硬脊膜撕裂是脊柱手术的常见并发症。然而，文献报道的发生率差异很大，主要基于单一外科医生或机构的相对较小的病例数量。
为脊柱外科医生提供脊柱手术中硬脊膜撕裂的可靠发生率，并评估可能影响硬脊膜撕裂风险的各种因素。
我们前瞻性评估了 2004 年至 2007 年期间，脊柱研究学会成员向一个匿名数据库提交的 108478 例手术病例。
在所有病例中，硬脊膜撕裂的发生率为 1.6%（1745/108478）。基于术前诊断，硬脊膜撕裂的发生率范围为 1.1%至 1.9%，其中治疗后脊柱后凸畸形（1.9%）或脊椎滑脱症（1.9%）的患者发生率最高，治疗脊柱侧凸的患者发生率最低（1.1%）。脊柱手术最常见的指征是退行性脊柱疾病，在这些患者中，颈椎（1.0%）与胸椎（2.2%；P=0.01）或腰椎（2.1%，P<0.001）病例的硬脊膜撕裂发生率较低。脊柱侧凸手术进一步按病因分类，其中退行性亚组的硬脊膜撕裂发生率最高（2.2%比 1.1%；P<0.001）。与初次手术相比，翻修手术中硬脊膜撕裂更为常见（2.2%比 1.5%；P<0.001），在年龄较大（>80 岁）的患者中更为常见（2.2%比 1.6%；P=0.006）。硬脊膜撕裂与新的神经功能缺损的发生之间存在显著相关性（P<0.001）。
即使在经验丰富的外科医生中，硬脊膜撕裂也至少发生在 1.6%的脊柱手术中。我们的数据提供了硬脊膜撕裂率的一般基准，并为持续努力提高护理安全性提供了基础。
