Yoshihara Hiroyuki, Yoneoka Daisuke
*Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY †Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.
J Spinal Disord Tech. 2015 Feb;28(1):19-24. doi: 10.1097/BSD.0000000000000071.
This was a retrospective study.
To report the incidence of incidental dural tear (DT) in cervical spine surgery, risk factors, and in-hospital patient outcomes on a national level.
DT during cervical spine surgery is not as common as that during lumbar spine surgery; however, DT is still a difficult complication.
Clinical data were obtained from the US Nationwide Inpatient Sample for 2009. Patients who underwent cervical spine surgery were identified and divided into those with and without DT according to the International Classification of Diseases, 9th revision, Clinical Modification codes. The patient and health care system-related demographic data were retrieved. The incidence of DT and patient outcomes were analyzed. A multivariate logistic regression analysis was performed to identify the risk factors for DT.
The incidence of DT was 0.45% (855/190,021). The multivariate analysis revealed that a diagnosis of myelopathy and ossification of the posterior longitudinal ligament; posterior approach, anterior and posterior approach; and insurance status were the significant risk factors for DT. Comparison between patients with and without DT showed that those with DT had significantly higher overall in-hospital complications (21.6% vs. 7.3%), longer hospital stays (6.0 vs. 3.2 d), a lower proportion who were discharged home routinely (66.3% vs. 83.9%), increased total hospital costs ($96,424 vs. $62,416), and similar in-hospital mortality (0.6% vs. 0.4%).
The incidence of DT in cervical spine surgery was 0.45% in the United States. The risk of DT was highest with a primary diagnosis of the ossification of the posterior longitudinal ligament (58.4 times). DT significantly increased the rate of in-hospital complications and health care burden.
这是一项回顾性研究。
报告全国范围内颈椎手术中意外硬脊膜撕裂（DT）的发生率、危险因素及住院患者的结局。
颈椎手术中的DT不如腰椎手术中常见；然而，DT仍是一种棘手的并发症。
从2009年美国全国住院患者样本中获取临床数据。识别接受颈椎手术的患者，并根据《国际疾病分类》第9版临床修订版编码将其分为有DT和无DT两组。检索患者及与医疗保健系统相关的人口统计学数据。分析DT的发生率及患者结局。进行多因素逻辑回归分析以确定DT的危险因素。
DT的发生率为0.45%（855/190,021）。多因素分析显示，脊髓病和后纵韧带骨化的诊断；后路、前后联合入路；以及保险状况是DT的显著危险因素。有DT和无DT患者的比较表明，有DT的患者总体住院并发症显著更高（21.6%对7.3%），住院时间更长（6.0天对3.2天），常规出院回家的比例更低（66.3%对83.9%），总住院费用增加（96,424美元对62,416美元），且住院死亡率相似（0.6%对0.4%）。
在美国，颈椎手术中DT的发生率为0.45%。后纵韧带骨化的初步诊断时DT的风险最高（58.4倍）。DT显著增加了住院并发症发生率和医疗负担。
