Department of Orthopaedic Surgery, University Hospital of Bordeaux, Spinal Unit, Place Amélie Raba Léon, Bordeaux, France.
Injury. 2012 Apr;43(4):397-401. doi: 10.1016/j.injury.2010.12.014. Epub 2011 Jan 19.
Retrospective review of a series of patients who underwent spinal surgery at a single spine unit during a 1 year period.
To assess the incidence, treatment, clinical consequence, complications of incidental durotomy during spine surgery and results of 37 months clinical follow-up.
Incidental durotomy is an underestimated and relatively adverse event during spinal surgery. Several consequences of inadequately treated dural tears have been reported.
A retrospective review was conducted on 1326 consecutive patients who underwent spinal surgery performed in one French spine unit from January 2005 to December 2005. We excluded from this study patients treated for emergency spine cases.
Fifty-one dural tears were identified (3.84%). Incidental durotomies were associated with anterior cervical approach in 1 case, with posterior cervical approach in 1 case, with anterior retroperitoneal approach in 1 case and with posterior thoracolumbar approach in 48 cases. In addition, any clinically significant durotomy unrecognised during surgical procedure were included. Thirteen patients presented postoperative complications including 7 cerebrospinal fluid leaks, 2 wound infections, 2 postoperative haematomas, and 2 pseudomeningoceles. Nine of these 13 patients required a revision procedure. A mean follow-up of 37 months showed good long-term clinical results.
Incidental durotomy is a common complication of spine surgery. All incidental durotomies must be repaired primarily. Dural tears that were immediately recognised and treated accordingly did not lead to any significant sequelae at a mean follow-up of 37 months. However, long-term follow-up studies will be needed to confirm this finding. The risks associated with dural tears and cerebrospinal fluid leaks are serious and should be discussed with any patients undergoing spine surgery.
对在一个脊柱外科单元接受脊柱手术的一系列患者进行回顾性研究，观察时间为 1 年。
评估脊柱手术中偶然发生的硬脊膜撕裂的发生率、治疗方法、临床后果、并发症，以及 37 个月的临床随访结果。
偶然发生的硬脊膜撕裂是脊柱手术中被低估的、相对不利的事件。已有报道称，硬脊膜撕裂若处理不当会产生多种后果。
回顾性分析了 2005 年 1 月至 12 月在法国一家脊柱外科单元接受脊柱手术的 1326 例连续患者的病历资料。本研究排除了因急症接受脊柱手术的患者。
共发现 51 例硬脊膜撕裂（3.84%）。其中，1 例与前路颈椎入路相关，1 例与后路颈椎入路相关，1 例与前路腹膜后入路相关，48 例与后路胸腰椎入路相关。此外，本研究还包括术中未发现但有临床意义的硬脊膜撕裂。13 例患者出现术后并发症，包括 7 例脑脊液漏、2 例伤口感染、2 例术后血肿和 2 例假性脑脊膜膨出。这 13 例患者中有 9 例需要进行翻修手术。平均 37 个月的随访结果显示长期临床效果良好。
偶然发生的硬脊膜撕裂是脊柱手术的常见并发症。所有偶然发生的硬脊膜撕裂都必须进行一期修复。立即发现并相应处理的硬脊膜撕裂在平均 37 个月的随访中没有导致任何明显的后遗症。然而，需要进行长期随访研究来证实这一发现。硬脊膜撕裂和脑脊液漏的风险是严重的，应在所有接受脊柱手术的患者中进行讨论。
