Department of Orthopedics and Sports Medicine, University of Washington, 1959 Pacific Ave. NE, Box 356500, Seattle, WA 98195, USA.
Spine J. 2012 Feb;12(2):121-6. doi: 10.1016/j.spinee.2012.01.012. Epub 2012 Feb 18.
Incidental durotomy during spine surgery is a common occurrence, with a reported incidence ranging from 3% to 16%. Risk factors identified by prior studies include age, type of procedure, revision surgery, ossification of the posterior longitudinal ligament, gender, osteoporosis, and arthritis. However, these studies are largely univariate analyses using retrospectively recorded data.
To identify and quantify statistically significant risk factors for inadvertent durotomy during spine surgery.
Multivariate analysis of prospectively collected registry data. The University of Washington Spine End Results Registry 2003 and 2004 is a compilation of prospectively collected detailed data on 1,745 patients who underwent spine surgery during 2003 to 2004.
One thousand seven hundred forty-five patients underwent spine surgery from 2003 to 2004 at our two institutions.
Cardiac, pulmonary, gastrointestinal, neurologic, renal, and urologic complications defined a priori data collection.
Using these data, univariate and multivariate statistical analyses were performed to identify and quantify risk factors for incidental durotomy during spine surgery. Relative risk (RR) values with valid confidence intervals and p values were determined using these data.
Our multivariate analysis demonstrated that age, lumbar surgery, revision surgery, and elevated surgical invasiveness are significant risk factors for unintended durotomy. Of these, revision surgery was the strongest risk factor for dural tear (RR, 2.21). Diabetes was a significant risk factor in the univariate analysis but not in the multivariate analysis.
Revision surgery, age, lumbar surgery, degenerative disease, and elevated surgical invasiveness are significant risk factors for unintended durotomy during spine surgery. These data can be useful to surgeons and patients when considering surgical treatment.
脊柱手术中偶然发生硬脊膜切开术是一种常见的情况，据报道其发生率为 3%至 16%。先前的研究确定的风险因素包括年龄、手术类型、翻修手术、后纵韧带骨化、性别、骨质疏松症和关节炎。然而，这些研究主要是使用回顾性记录数据进行的单变量分析。
确定并量化脊柱手术中硬脊膜切开术意外发生的统计学显著风险因素。
前瞻性收集登记数据的多变量分析。华盛顿大学脊柱手术结果登记处 2003 年和 2004 年是一项前瞻性收集的详细数据汇编，涉及 2003 年至 2004 年期间接受脊柱手术的 1745 名患者。
我们的两家机构在 2003 年至 2004 年期间对 1745 名患者进行了脊柱手术。
预先设定的数据收集定义了心脏、肺部、胃肠道、神经、肾脏和泌尿科并发症。使用这些数据，进行了单变量和多变量统计分析，以确定和量化脊柱手术中硬脊膜切开术意外发生的风险因素。使用这些数据确定了具有有效置信区间和 p 值的相对风险 (RR) 值。
我们的多变量分析表明，年龄、腰椎手术、翻修手术和手术侵袭性增加是硬脊膜切开术意外发生的显著风险因素。在这些因素中，翻修手术是硬脊膜撕裂的最强风险因素（RR，2.21）。糖尿病在单变量分析中是一个显著的风险因素，但在多变量分析中不是。
翻修手术、年龄、腰椎手术、退行性疾病和手术侵袭性增加是脊柱手术中硬脊膜切开术意外发生的显著风险因素。这些数据在考虑手术治疗时对外科医生和患者都有用。
