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单侧双门通道脊柱内镜手术中的硬膜损伤

Dural Injury in Unilateral Biportal Endoscopic Spinal Surgery.

作者信息

Lee Han Gyu, Kang Moo Sung, Kim So Yeon, Cho Kwang Chun, Na Young Cheol, Cho Jin Mo, Jin Byung Ho

机构信息

395886Catholic Kwandong University, International St. Mary's Hospital, Incheon, Republic of Korea.

H plus Yangji Hospital, Seoul, Republic of Korea.

出版信息

Global Spine J. 2021 Jul;11(6):845-851. doi: 10.1177/2192568220941446. Epub 2020 Aug 7.


DOI:10.1177/2192568220941446
PMID:32762357
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8258823/
Abstract

STUDY DESIGN: Retrospective study. OBJECTIVES: Unilateral biportal endoscopic surgery (UBES) is a popular surgical method used to treat degenerative spinal diseases because of its merits, such as reduced tissue damage and outstanding visual capacity. However, dural injury is the most common complication of UBES with an incidence rate of 1.9% to 5.8%. The purpose of this study was to analyze the pattern of dural injury during UBES and to report the clinical course. METHODS: We retrospectively reviewed the medical and radiographic records of surgically treated patients who underwent UBES at a single institute between January 2018 and December 2019. RESULTS: Fifty-three patients, representing 67 segments, underwent UBES. Seven dural injuries occurred, and the incidence rate was 13.2%. Among 16 far lateral approaches, 2 dural injuries of the exiting roots occurred and were treated with fibrin sealant reinforcement. Among 51 median approaches, dural injury occurred at the thecal sac (n = 3) and traversing root (n = 2). A dural injury of the shoulder of the traversing root was treated with a fibrin sealant; however, a defect in the thecal sac required a revision for reconstruction. The other 2 thecal sac injuries were directly repaired via microscopic surgery. CONCLUSIONS: Dural injury during UBES can occur because of the various anatomical features of the meningo-vertebral ligaments. Direct repair of the central dural defect should be considered under microscopic vision. A linear tear in the lateral dura or root can be controlled with a simple patchy reinforcement under endoscopic vision.

摘要

研究设计:回顾性研究。 目的:单侧双通道内镜手术(UBES)因其组织损伤小、视野良好等优点,是治疗退行性脊柱疾病常用的手术方法。然而,硬脊膜损伤是UBES最常见的并发症,发生率为1.9%至5.8%。本研究旨在分析UBES术中硬脊膜损伤的模式并报告临床过程。 方法:我们回顾性分析了2018年1月至2019年12月在单一机构接受UBES手术治疗患者的医疗和影像学记录。 结果:53例患者共67节段接受了UBES手术。发生7例硬脊膜损伤,发生率为13.2%。在16例远外侧入路中,2例出现出口神经根硬脊膜损伤,采用纤维蛋白胶加固治疗。在51例正中入路中,硬脊膜损伤发生在硬脊膜囊(n = 3)和走行神经根(n = 2)。走行神经根肩部的硬脊膜损伤采用纤维蛋白胶治疗;然而,硬脊膜囊缺损需要翻修重建。另外2例硬脊膜囊损伤通过显微手术直接修复。 结论:由于脊膜-椎体韧带的各种解剖特征,UBES术中可能发生硬脊膜损伤。中央硬脊膜缺损应在显微镜下直视下考虑直接修复。外侧硬脊膜或神经根的线性撕裂可在内镜直视下通过简单的补片加固来控制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c00f/8258823/258a7ec8124e/10.1177_2192568220941446-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c00f/8258823/3be655204660/10.1177_2192568220941446-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c00f/8258823/35ad7fe1fa14/10.1177_2192568220941446-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c00f/8258823/258a7ec8124e/10.1177_2192568220941446-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c00f/8258823/3be655204660/10.1177_2192568220941446-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c00f/8258823/35ad7fe1fa14/10.1177_2192568220941446-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c00f/8258823/258a7ec8124e/10.1177_2192568220941446-fig3.jpg

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[3]
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[4]
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[5]
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[6]
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[9]
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[10]
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本文引用的文献

[1]
Pseudomeningocele after biportal endoscopic spine surgery: A case report.

J Orthop. 2019-10-25

[2]
Incidental Durotomy During Endoscopic Stenosis Lumbar Decompression: Incidence, Classification, and Proposed Management Strategies.

World Neurosurg. 2020-7

[3]
Dural Tears in Percutaneous Biportal Endoscopic Spine Surgery: Anatomical Location and Management.

World Neurosurg. 2020-4

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World Neurosurg. 2020-2

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Neurospine. 2019-3

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Outcomes of endoscopic discectomy compared with open microdiscectomy and tubular microdiscectomy for lumbar disc herniations: a meta-analysis.

J Neurosurg Spine. 2019-9-6

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Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis.

Asian Spine J. 2019-4

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Biportal Endoscopic Spinal Surgery for Bilateral Lumbar Foraminal Decompression by Switching Surgeon's Position and Primary 2 Portals: A Report of 2 Cases With Technical Note.

Neurospine. 2019-3

[9]
Endoscopic Treatment of Extraforaminal Entrapment of L5 Nerve Root (Far Out Syndrome) by Unilateral Biportal Endoscopic Approach: Technical Report and Preliminary Clinical Results.

Neurospine. 2019-3

[10]
Endoscopic Lumbar Surgery: The State of the Art in 2019.

Neurospine. 2019-3

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