Aspalter Stefan, Senker Wolfgang, Radl Christian, Aichholzer Martin, Aufschnaiter-Hießböck Kathrin, Leitner Clemens, Stroh Nico, Trutschnig Wolfgang, Gruber Andreas, Stefanits Harald
Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
Department of Mathematics, University of Salzburg, Salzburg, Austria.
Front Surg. 2021 Jul 20;8:708243. doi: 10.3389/fsurg.2021.708243. eCollection 2021.
One of the most frequent complications of spinal surgery is accidental dural tears (ADTs). Minimal access surgical techniques (MAST) have been described as a promising approach to minimizing such complications. ADTs have been studied extensively in connection with open spinal surgery, but there is less literature on minimally invasive spinal surgery (MISS). We reviewed 187 patients who had undergone degenerative lumbar spinal surgery using minimally invasive spinal fusions techniques. We analyzed the influence of age, Body Mass Index (BMI), smoking, diabetes, and previous surgery on the rate of ADTs in MISS. Twenty-two patients (11.764%) suffered from an ADT. We recommended bed rest for two and a half to 5 days, depending on the type of repair required and the amount of cerebrospinal fluid (CSF) leakage. We could not find any statistically significant correlation between ADTs and age ( = 0.34,), BMI ( = 0.92), smoking ( = 0.46), and diabetes ( = 0.71). ADTs were significantly more frequent in cases of previous surgery ( < 0.001). None of the patients developed a transcutaneous CSF leak or post-operative infection. The frequency of ADTs in MISS appears comparable to that encountered when using open surgical techniques. Additionally, MAST produces less dead space along the corridor to the spine. Such reduced dead space may not be enough for pseudomeningocele to occur, cerebrospinal fluid to accumulate, and fistula to form. MAST, therefore, provides a certain amount of protection.
脊柱手术最常见的并发症之一是意外硬脊膜撕裂（ADT）。微创外科技术（MAST）已被描述为一种有望将此类并发症降至最低的方法。ADT已在开放脊柱手术中得到广泛研究，但关于微创脊柱手术（MISS）的文献较少。我们回顾了187例接受微创脊柱融合技术进行退行性腰椎手术的患者。我们分析了年龄、体重指数（BMI）、吸烟、糖尿病和既往手术对MISS中ADT发生率的影响。22例患者（11.764%）发生了ADT。根据所需修复类型和脑脊液（CSF）漏出量，我们建议卧床休息2.5至5天。我们未发现ADT与年龄（=0.34）、BMI（=0.92）、吸烟（=0.46）和糖尿病（=0.71）之间存在任何统计学上的显著相关性。既往手术患者中ADT的发生率显著更高（<0.001）。所有患者均未出现经皮脑脊液漏或术后感染。MISS中ADT的发生率似乎与开放手术技术时相当。此外，MAST沿脊柱通道产生的死腔较小。这种减少的死腔可能不足以形成假性脑脊膜膨出、脑脊液积聚和瘘管。因此，MAST提供了一定程度的保护。
