Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-2, Hiroo, Shibuya-Ku, Tokyo 150-8935, Japan.
Spine J. 2020 Dec;20(12):1968-1975. doi: 10.1016/j.spinee.2020.06.009. Epub 2020 Jun 13.
Unintended dural tears (DTs) are common in spinal surgeries. Some authors have reported that the outcomes in lumbar surgery patients with DTs are equivalent to those in patients without DTs, but this remains uncertain.
To assess the effect of unintended DTs on postoperative patient-reported outcomes.
STUDY DESIGN/SETTING: A multicenter retrospective observational study.
We enrolled patients undergoing lumbar spine surgery at eight hospitals between April 2017 and November 2018.
We collected data regarding patients' backgrounds, operative factors, occurrence of unplanned DTs during surgery, postoperative complications, patient-reported outcomes, such as pain or dysesthesia of the lower back, buttock, leg, or plantar area, EuroQol 5 Dimension (EQ-5D), Oswestry Disability Index (ODI) scores, and postoperative satisfaction.
We divided the patients into a DT- group (without DTs) and a DT+ group (with DTs). First, multivariate logistic regression analyses were conducted to reveal risk factors for occurrence of DTs. Then, we used propensity score matching to obtain a matched DT- group (mDT- group) and a matched DT+ (mDT+ group). Student's t test was used for comparing continuous variables and Pearson's chi-square test for comparing categorical variables between the two groups.
We enrolled 2,146 patients in this study. The number of patients with unintended DTs was 166 (7.7%). Older age, body mass index, ossification of posterior longitudinal ligament / yellow ligament, spinal deformity, and revision surgery were significant risk factors for DTs. We used propensity score matching to compare 163 of the patients with DTs with 163 patients without DTs. No significant difference was found in postoperative pain or dysesthesia of the lower back, buttock, leg, and plantar area between the mDT- and mDT+ groups. When comparing preoperative with postoperative pain and dysesthesia, a statistically significant improvement was found in each group (p<.01 for all variables) except for sensory disorder of the plantar area, where a significant improvement was only observed in dysesthesia of the mDT- group (p<.01). Although some improvements were observed, they were not statistically significant in terms of pain in the mDT- (p=.06) and mDT+ (p=.13) groups and dysesthesia in the mDT+ (p=.13) group. No significant differences were found in postoperative outcomes, such as EQ-5D (p=.44) and ODI (p=.89) scores, and postoperative satisfaction (p=.73) between the two groups.
Although insufficient improvement of sensory disorder of the plantar area was observed, patients with DTs showed almost equivalent postoperative outcomes compared with patients without DTs.
在脊柱手术中，意外的硬脑膜撕裂（DTs）很常见。一些作者报告称，DTs 患者在腰椎手术后的结果与无 DTs 患者相当，但这仍不确定。
评估意外 DTs 对术后患者报告结果的影响。
研究设计/设置：多中心回顾性观察性研究。
我们在 2017 年 4 月至 2018 年 11 月期间在八家医院招募了接受腰椎手术的患者。
我们收集了患者背景、手术因素、术中意外 DTs 的发生、术后并发症、患者报告的结果（如腰痛、臀部、腿部或足底区域的疼痛或感觉异常）、EuroQol 5 维度（EQ-5D）、Oswestry 残疾指数（ODI）评分和术后满意度。
我们将患者分为 DT-组（无 DTs）和 DT+组（有 DTs）。首先，进行多变量逻辑回归分析以揭示 DTs 发生的危险因素。然后，我们使用倾向评分匹配来获得匹配的 DT-组（mDT-组）和匹配的 DT+组（mDT+组）。使用 Student's t 检验比较两组间的连续变量，使用 Pearson's chi-square 检验比较分类变量。
本研究共纳入 2146 例患者。意外 DTs 的患者人数为 166 例（7.7%）。年龄较大、体重指数、后纵韧带/黄韧带骨化、脊柱畸形和翻修手术是 DTs 的显著危险因素。我们使用倾向评分匹配比较了 163 例 DTs 患者和 163 例无 DTs 患者。在 mDT-组和 mDT+组之间，术后腰痛、臀部、腿部和足底区域的疼痛或感觉异常无显著差异。与术前相比，术后疼痛或感觉异常在每组中均有显著改善（所有变量 p<.01），除足底区域感觉障碍外，mDT-组感觉异常有显著改善（p<.01）。尽管观察到一些改善，但 mDT-组（p=.06）和 mDT+组（p=.13）的疼痛以及 mDT+组（p=.13）的感觉异常均无统计学意义。两组术后结局（EQ-5D，p=.44；ODI，p=.89）和术后满意度（p=.73）无显著差异。
尽管观察到足底区域感觉障碍改善不足，但 DTs 患者的术后结果与无 DTs 患者几乎相当。
