Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Orthopaedic and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Straße 9, 50924, Cologne, Germany.
Eur Spine J. 2017 Oct;26(10):2483-2495. doi: 10.1007/s00586-017-5197-1. Epub 2017 Jun 20.
The three aims of this Spine Tango registry study of patients undergoing decompression for spinal stenosis were to: report the rate of dural tear (DT) stratified by treatment centre; find factors associated with an increased likelihood of incurring a DT; and compare treatment outcomes in relation to DT (none vs. repaired vs. unrepaired DT).
Multivariate logistic regression was used to assess the association between DT and patient and treatment characteristics. Patient-rated and surgical outcomes were compared in patients with no DT, repaired DT, and unrepaired DT, while adjusting for case-mix.
DT occurred in 328/3254 (10.1%) of included patients. The rate for all 29 contributing hospitals was within 95% confidence intervals of the average. The likelihood of DT increased by 2% per year of age, 1.78 times with previous spine surgery, 1.67 for a minimally/less invasive surgery, 1.58 times with laminectomy, and 1.40, and 2.12 times for BMI 31-35, and >35 in comparison with BMI 26-30, respectively. The majority of DTs (272/328; 82.9%) were repaired. Repairing the DT was associated with a longer duration of surgery (p < 0.001). More patients with repaired than with unrepaired DTs were satisfied with treatment, but the difference was not statistically significant. There was no association between DT and patient-reported outcomes.
The unadjusted rate of incidental DT during decompression for LSS was homogeneous across the participating centres and was associated with age, BMI, previous surgery at the same spinal level, minimally/less invasive surgery, and laminectomy. Non-repair of DTs had no negative association with treatment outcome; however, the unrepaired DTs may have been those that were smaller in size.
本研究旨在通过对因腰椎管狭窄症而行减压手术的患者进行脊柱探戈注册研究，以实现以下三个目标：报告按治疗中心分层的硬脊膜撕裂（DT）发生率；寻找与发生 DT 风险增加相关的因素；并比较与 DT（无 DT、修复 DT 和未修复 DT）相关的治疗结果。
采用多变量逻辑回归评估 DT 与患者和治疗特征之间的关联。在调整病例组合的情况下，比较无 DT、修复 DT 和未修复 DT 的患者的患者自评和手术结果。
3254 例纳入患者中有 328 例（10.1%）发生 DT。29 家参与医院的发生率均在平均置信区间内。年龄每增加 1 岁，DT 的可能性增加 2%，有先前脊柱手术史的可能性增加 1.78 倍，微创手术/较少侵入性手术的可能性增加 1.67 倍，椎板切除术的可能性增加 1.58 倍，与 BMI 26-30 相比，BMI 31-35 和>35 的可能性分别增加 1.40 倍和 2.12 倍。大多数 DT（272/328；82.9%）得到了修复。修复 DT 与手术时间延长相关（p<0.001）。与未修复 DT 相比，更多修复 DT 的患者对治疗满意，但差异无统计学意义。DT 与患者报告的结果之间没有关联。
在参与的中心中，LSS 减压术中偶然发生的 DT 的未调整发生率是同质的，与年龄、BMI、同一脊柱水平的先前手术、微创手术/较少侵入性手术和椎板切除术相关。未修复 DT 与治疗结果无不良关联；然而，未修复的 DT 可能尺寸较小。
