Takaoka Hiromitsu, Orita Sumihisa, Inage Kazuhide, Shiga Yasuhiro, Eguchi Yawara, Ohtori Seiji
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Chiba University Center for Frontier Medical Engineering, Chiba, Japan.
J Orthop Case Rep. 2022 Nov;12(11):71-75. doi: 10.13107/jocr.2022.v12.i11.3420.
Post-operative urinary retention is a common complication of posterior spine surgery for lumbar spinal stenosis. However, it can result in considerable difficulty for the patient, especially when it is severe, as in cases of complete retention. Therefore, it is crucial to consider its risk factors. This report provides a retrospective review of cases with severe post-operative urinary retention with the aim of elucidating its possible risk factors.
Data of five patients with post-operative urinary retention after posterior spine surgery for lumbar spinal stenosis, operated in our facility from 2013 to 2020, were analyzed. Their age, preoperative Japanese Orthopaedic Association (JOA) score, presence of pre-operative bladder and bowel disorders (BBD), presence of pre-operative muscle weakness, the mean number of vertebral levels operated on, complications such as intraoperative dural tear and hematoma, operative time, estimated blood loss, JOA score in the early post-operative period, and the recovery period for the urinary retention symptoms were examined. The mean pre-operative JOA score was 8.4, and the mean number of operated levels was 2.8. The incidence of pre-operative BBD, pre-operative muscle weakness, intraoperative dural tears, and post-operative hematoma was two each. The mean operative time was 242 min, mean estimated blood loss was 352 g, and the mean JOA score in the early post-operative period was 5.8. The recovery period for urinary retention ranged from 4 days to 9 months postoperatively; one patient also had cervical and thoracic spinal stenosis and underwent decompression of all stenotic levels for relief from complete urinary retention.
In our retrospective review of cases with severe post-operative urinary retention after lumbar spinal stenosis surgery, all patients had severe pre-operative symptoms and spinal stenosis at multiple levels. An awareness of potential risk factors and carefully and gently performing the intraoperative procedures can facilitate lesser damage to the spinal nerve.
术后尿潴留是腰椎管狭窄后路脊柱手术常见的并发症。然而，它会给患者带来相当大的困扰，尤其是在严重的情况下，如完全性尿潴留。因此，考虑其危险因素至关重要。本报告对严重术后尿潴留病例进行回顾性分析，旨在阐明其可能的危险因素。
分析了2013年至2020年在我院接受腰椎管狭窄后路脊柱手术且术后出现尿潴留的5例患者的数据。检查了他们的年龄、术前日本矫形外科学会（JOA）评分、术前膀胱和肠道功能障碍（BBD）的存在情况、术前肌肉无力的存在情况、手术的平均椎体节段数、术中硬脊膜撕裂和血肿等并发症、手术时间、估计失血量、术后早期JOA评分以及尿潴留症状的恢复时间。术前JOA评分平均为8.4，平均手术节段数为2.8。术前BBD、术前肌肉无力、术中硬脊膜撕裂和术后血肿的发生率均为2例。平均手术时间为242分钟，平均估计失血量为352克，术后早期JOA评分平均为5.8。尿潴留的恢复时间为术后4天至9个月；1例患者还患有颈椎和胸椎椎管狭窄，为缓解完全性尿潴留接受了所有狭窄节段的减压手术。
在我们对腰椎管狭窄手术后严重术后尿潴留病例的回顾性分析中，所有患者术前均有严重症状且存在多个节段的椎管狭窄。认识到潜在危险因素并在术中仔细轻柔操作，可减少对脊神经的损伤。
