Alshameeri Zeiad A F, Jasani Vinay
University Hospital of North Midlands, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
Int J Spine Surg. 2021 Jun;15(3):536-548. doi: 10.14444/8082. Epub 2021 May 13.
Accidental dural tears (DTs) are familiar complications of spinal surgery. Their reported incidence varies widely, and several risk factors have been proposed in the literature. The aim of this study was to conduct a systematic review and meta-analysis to determine the rate of DTs and assess their associated risk factors.
A systematic literature search was conducted using specific MeSH and Text terms. Only articles with prospective data reporting the incidence and risk factors were selected and reviewed based on specific inclusion and exclusion criteria.
Twenty-three studies were included. The reported incidence rate ranged from 0.4% to 15.8%, giving an overall pooled incidence rate of 5.8% (95% confidence interval [CI] 4.4-7.3). The incidence rate varied in relation to the part of the spine and the type of surgery. Three factors were associated with a high rate of DTs: age (overall mean difference of 3.04, 95% CI 2.49-3.60), revision surgery (overall odds ratio of 2.28, 95% CI 1.84-2.83), and lumbar stenosis (overall odds ratio of 2.03, 95% CI 1.50-2.75). Diabetes was weakly associated with DTs, with an odds ratio of 1.40 (95% CI 1.01-1.93). The overall effects of sex and obesity were not statistically significant.
Advancing age, revision surgery, and lumbar stenosis were significantly associated with increased risk of DTs. These factors should be taken into consideration during the consenting process for spinal surgery.
Risk of dural tear during spine surgery.
意外硬脊膜撕裂是脊柱手术常见的并发症。其报道的发生率差异很大，文献中已提出了几个危险因素。本研究的目的是进行系统评价和荟萃分析，以确定硬脊膜撕裂的发生率，并评估其相关危险因素。
使用特定的医学主题词（MeSH）和文本术语进行系统的文献检索。仅根据特定的纳入和排除标准选择并审查了具有前瞻性数据报告发生率和危险因素的文章。
纳入了23项研究。报道的发生率范围为0.4%至15.8%，总体合并发生率为5.8%（95%置信区间[CI]4.4 - 7.3）。发生率因脊柱部位和手术类型而异。三个因素与硬脊膜撕裂的高发生率相关：年龄（总体平均差异为3.04，95%CI 2.49 - 3.60）、翻修手术（总体优势比为2.28，95%CI 1.84 - 2.83）和腰椎管狭窄（总体优势比为2.03，95%CI 1.50 - 2.75）。糖尿病与硬脊膜撕裂的相关性较弱，优势比为1.40（95%CI 1.01 - 1.93）。性别和肥胖的总体影响无统计学意义。
年龄增长、翻修手术和腰椎管狭窄与硬脊膜撕裂风险增加显著相关。在脊柱手术的知情同意过程中应考虑这些因素。
脊柱手术期间硬脊膜撕裂的风险。
