Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
J Neurosurg Spine. 2014 Aug;21(2):279-85. doi: 10.3171/2014.3.SPINE13719. Epub 2014 May 9.
Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature.
A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively.
Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30-74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery.
Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.
近年来，微创外科（MIS）越来越多地用于治疗各种椎管内脊髓病变。尽管 MIS 技术可成功治疗椎管内病变，但由于管状牵开器系统的手术通道有限，MIS 中的硬脑膜初次缝合可能具有技术挑战性。作者描述了他们在单中心对 23 例接受椎管内病变的 MIS 治疗的患者的经验，并回顾了相关文献。
对 2006 年 11 月至 2013 年 7 月间接受椎管内脊髓病变的 MIS 治疗的患者前瞻性收集的手术数据库进行回顾性分析。患者的人口统计学、术前记录、手术记录和术后记录均进行了回顾。主要结局包括手术时间、估计失血量、卧床休息时间、住院时间和术后并发症，这些并发症均进行了前瞻性记录。
研究期间，共确定了 23 例接受椎管内脊髓病变的 MIS 治疗的患者。15 例（65.2%）为女性，8 例（34.8%）为男性。手术时的平均年龄为 54.4 岁（范围 30-74 岁）。手术病变包括肿瘤（17 例）、先天性（3 例）、血管性（2 例）和退行性（1 例）。最常见的治疗部位是腰椎（11 例），其次是胸椎（9 例）、颈椎（2 例）和骶骨（1 例）。平均手术时间为 161.1 分钟，平均估计失血量为 107.2ml。所有患者术后 24 小时内即可进行全面活动。中位住院时间为 78.2 小时。所有病例均使用专门的 MIS 器械实现了硬脑膜的初次缝合，并辅以纤维蛋白胶。术后头痛、恶心、呕吐和复视的发生率为 0%。在随访中未发现术后脑脊液漏或症状性假性脑脊膜膨出病例，也无患者需要再次手术。
在椎管内脊髓病变的 MIS 治疗中，硬脑膜初次缝合后早期活动是一种有效的策略，可获得良好的临床结果。成功进行初次硬脑膜缝合后，长时间卧床休息似乎是不必要的，而且在特定的患者人群中，不应因为需要硬脑膜严密缝合而阻止使用 MIS 技术。
