Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
J Neurosurg Spine. 2012 Jul;17(1):30-6. doi: 10.3171/2012.3.SPINE11939. Epub 2012 Apr 27.
Incidental durotomies (IDs) are an unfortunate but anticipated potential complication of spinal surgery. The authors surveyed the frequency of IDs for a single spine surgeon and analyzed the major risk factors as well as the impact on long-term patient outcomes.
The authors conducted a prospective review of elective spinal surgeries performed over a 15-year period. Any surgery involving peripheral nerve only, intradural procedures, or dural tears due to trauma were excluded from analysis. The incidence of ID was categorized by surgery type including primary surgery, revision surgery, and so forth. Incidence of ID was also examined in the context of years of physician experience and training. Furthermore, the incidence and types of sequelae were examined in patients with an ID.
Among 3000 elective spinal surgery cases, 3.5% (104) had an ID. The incidence of ID during minimally invasive procedures (3.3%) was similar, but no patients experienced long-term sequelae. The incidence of ID during revision surgery (6.5%) was higher. There was a marked difference in incidence between cervical (1.3%) and thoracolumbar (5.1%) cases. The incidence was lower for cases involving instrumentation (2.4%). When physician training was examined, residents were responsible for 49% of all IDs, whereas fellows were responsible for 26% and the attending for 25%. Among all of the cases that involved an ID, 7.7% of patients went on to experience a neurological deficit as compared with 1.5% of those without an ID. The overall failure rate of dural repair was 6.9%, and failure was almost 3 times higher (13%) in revision surgery as compared with a primary procedure (5%).
The authors established a reliable baseline incidence for durotomy after spine surgery: 3.5%. They also identified risk factors that can increase the likelihood of a durotomy, including location of the spinal procedure, type of procedure performed, and the implementation of a new procedure. The years of physician training or resident experience did not appear to be a major risk for ID.
偶然的硬脊膜切开术（IDs）是脊柱手术不幸但可预见的潜在并发症。作者调查了一位脊柱外科医生的 IDs 发生率，并分析了主要的危险因素以及对长期患者预后的影响。
作者对 15 年内进行的择期脊柱手术进行了前瞻性回顾。排除仅涉及外周神经、硬脊膜内手术或因创伤导致硬脊膜撕裂的手术。根据手术类型（包括初次手术、翻修手术等）对 IDs 的发生率进行分类。还检查了医生经验和培训年限方面 IDs 的发生率。此外，还检查了发生 IDs 的患者的后遗症发生率和类型。
在 3000 例择期脊柱手术中，有 3.5%（104 例）发生 IDs。微创手术中 IDs 的发生率（3.3%）相似，但没有患者出现长期后遗症。翻修手术中 IDs 的发生率（6.5%）更高。颈椎（1.3%）和胸腰椎（5.1%）病例的发生率差异显著。涉及器械的病例发生率较低（2.4%）。当检查医生培训时，住院医师导致所有 IDs 的 49%，研究员导致 26%，主治医生导致 25%。在所有涉及 IDs 的病例中，有 7.7%的患者出现神经功能缺损，而无 IDs 的患者为 1.5%。硬脊膜修复的总体失败率为 6.9%，翻修手术的失败率几乎是初次手术的 3 倍（13%对 5%）。
作者确定了脊柱手术后硬脊膜切开术的可靠基线发生率：3.5%。他们还确定了可能增加硬脊膜切开术可能性的危险因素，包括脊柱手术的部位、手术类型和新手术的实施。医生培训年限或住院医师经验似乎不是 IDs 的主要危险因素。
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