Robson Craig H, Paranathala Menaka P, Dobson Gareth, Ly Fabrice, Brown Daniel P, O'Reilly Gerry
a Department of Neurosurgery , Hull and East Yorkshire Hospitals NHS Trust Hull , United Kingdom of Great Britain and Northern Ireland.
b Department of Neurosurgery , Royal Victoria Infirmary, Newcastle-Upon-Tyne NHS Trust , Newcastle upon Tyne , United Kingdom of Great Britain and Northern Ireland.
Br J Neurosurg. 2018 Nov 4;32(6):592-594. doi: 10.1080/02688697.2018.1508641.
Unintended durotomy is a well-recognised complication of lumbar spine surgery. Reported complications include headaches, intracranial haematomata, pseudomeningocoele and infection. Methods of intraoperative repair vary and although post-operative flat bed rest is advocated by some, there is no consensus on duration. We reviewed a series of unintended durotomies that occurred in our institution and reviewed them to compare management strategies and outcome.
A retrospective analysis was conducted of adult patients who experienced an unintended durotomy during surgery for lumbar degenerative disease in our neurosurgical unit over a 15-month period. Post-operative complications were followed up for a minimum of 3 months.
1125 patients underwent elective or emergency decompressive lumbar spine surgery. 45 (4%) dural tears were identified; all were repaired intra-operatively with suturing, Tisseal thrombin glue or both. Absence of leakage was confirmed on Valsalva manoeuvre for all cases, before wound closure. 28 patients were mobilised within 24 hrs of surgery, 16 patients between 24-48 hours and 1 patient after 48 hours. Seven patients (16%) with a dural tear experienced a complication. There was no statistically significant relationship between time to post-operative mobilisation and complication rate (p = .76). There was a significantly longer inpatient stay when patients were on bed rest for longer (2 tailed test significant at the 2% level).
Duration of post-operative bed rest was not related to complication rate but led to delays in discharge. We did not find evidence that early mobilisation lead to increased likelihood of complications.
意外硬脊膜切开是腰椎手术中一种公认的并发症。报道的并发症包括头痛、颅内血肿、假性脑脊膜膨出和感染。术中修复方法各不相同，尽管一些人主张术后卧床休息，但对于卧床时间并无共识。我们回顾了在我们机构发生的一系列意外硬脊膜切开病例，并对其进行分析以比较管理策略和结果。
对在我们神经外科病房15个月期间因腰椎退行性疾病手术时发生意外硬脊膜切开的成年患者进行回顾性分析。术后并发症至少随访3个月。
1125例患者接受了择期或急诊减压性腰椎手术。发现45例（4%）硬脊膜撕裂；所有病例均在术中用缝合、凝血酶组织胶或两者进行修复。所有病例在伤口闭合前通过瓦尔萨尔瓦动作确认无渗漏。28例患者在术后24小时内活动，16例患者在24 - 48小时之间活动，1例患者在48小时后活动。7例（16%）硬脊膜撕裂患者出现并发症。术后活动时间与并发症发生率之间无统计学显著关系（p = 0.76）。患者卧床休息时间越长，住院时间显著延长（双尾检验在2%水平显著）。
术后卧床时间与并发症发生率无关，但导致出院延迟。我们没有发现早期活动会增加并发症可能性的证据。
