Erdoğan Uzay, Akpinar Aykut
Neurosurgery, University of Health Sciences, Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, TUR.
Neurosurgery, University of Health Sciences, Haseki Research and Training Hospital, Istanbul, TUR.
Cureus. 2021 Apr 8;13(4):e14360. doi: 10.7759/cureus.14360.
A dural tear (DT) is the most commonly encountered complication during lumbar spine surgery. The incidence of DT increases depending on the complexity of the surgical procedure and the presence of a DT is related to a poor outcome and patient satisfaction.
This study aimed to determine the incidence and clinical outcomes of DTs in those patients who undergo lumbar disc surgery.
We retrospectively reviewed consecutive patients who underwent surgery for the management of a primary single-level lumbar disc herniation at a single institution between 2004 and 2014. Among the studied population, those with DTs were included in the study group. An age- and sex-matched group of randomly selected patients who underwent the same level and type of lumbar spine surgery, but did not develop DTs, were assigned as the control group. The outcomes were compared at 12 months postoperatively between the groups.
A total of 5,476 consecutive patients (2,608 female, 2,868 male; mean age, 54 ± 11.45 [range, 21-86] years) underwent surgery for primary single-level lumbar disc herniation. DT was noted in 192 (2.85%) cases. Of these, 102 patients with complete data were included in the DT group. The DT group had a significantly increased length of hospital stay (p = 0.001). Also, the duration of bed rest in the hospital was significantly higher in patients wherein DT was repaired using hemostatic material and fibrin glue, compared to the patients with primary closure with suturing of the tear.
Incidental DTs, if recognized and treated appropriately, will not lead to poor clinical results and do not adversely impact postoperative outcomes.
硬脊膜撕裂（DT）是腰椎手术中最常见的并发症。DT的发生率随着手术操作的复杂性增加而升高，并且DT的出现与预后不良及患者满意度相关。
本研究旨在确定接受腰椎间盘手术患者中DT的发生率及临床结局。
我们回顾性分析了2004年至2014年间在单一机构接受原发性单节段腰椎间盘突出症手术的连续患者。在研究人群中，发生DT的患者被纳入研究组。随机选择年龄和性别匹配的、接受相同节段和类型腰椎手术但未发生DT的患者作为对照组。比较两组术后12个月的结局。
共有5476例连续患者（女性2608例，男性2868例；平均年龄54±11.45岁[范围21-86岁]）接受了原发性单节段腰椎间盘突出症手术。192例（2.85%）出现DT。其中，DT组纳入了102例有完整数据的患者。DT组的住院时间显著延长（p = 0.001）。此外，与采用撕裂处缝合进行一期闭合的患者相比，使用止血材料和纤维蛋白胶修复DT的患者在医院的卧床休息时间显著更长。
偶发性DT如果得到及时识别和恰当治疗，不会导致不良临床结果，也不会对术后结局产生不利影响。
