Cedars-Sinai Medical Center, Department of Orthopedics, 444 S San Vicente Blvd #901, Los Angeles, CA, 90048, USA.
Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Spine Deform. 2024 Sep;12(5):1277-1282. doi: 10.1007/s43390-024-00873-4. Epub 2024 May 23.
To characterize the frequency of incidental dural tears in pediatric spine surgery, their treatment, complications, and results of long-term follow-up.
A retrospective review of all pediatric patients who underwent a posterior spinal fusion (PSF) between 2004-2019 at a tertiary children's hospital was conducted. Electronic medical records were reviewed for patient demographics, intra-operative data, presence of an incidental dural tear, repair method, and patient outcomes.
3043 PSFs were reviewed, with 99 dural tears identified in 94 patients (3.3% overall incidence). Mean follow-up was 35.7 months (range 0.1-142.5). When the cause of the dural tear was specified, 69% occurred during exposure, 5% during pedicle screw placement, 4% during osteotomy, 2% during removal of implants, and 2% during intra-thecal injection of morphine. The rate of dural tears during primary PSF was significantly lower than during revision PSF procedures (2.6% vs. 6.2%, p < 0.05). 86.9% of dural tears were repaired and/or sealed intraoperatively, while 13.1% had spontaneous resolution. Postoperative headaches developed in 13.1% of patients and resolved at a mean of 7.6 days. There was no difference in the incidence of headaches in patients that were ordered bedrest vs. no bedrest (p > 0.99). Postoperative infections occurred in 9.5% of patients and 24.1% patients were identified to have undergone a revision surgery.
Incidence of intra-operative dural tears in pediatric spine surgery is 3.3%. Although complications associated with the dural tear occur, most resolve over time and there were no long-term sequelae in patients with 2 years of follow up.
Level IV.
描述儿童脊柱手术中偶然发生的硬脑膜撕裂的频率、治疗方法、并发症以及长期随访结果。
对 2004 年至 2019 年间在一家三级儿童医院接受后路脊柱融合术（PSF）的所有儿童患者进行了回顾性分析。对电子病历进行了回顾，以了解患者的人口统计学数据、术中数据、硬脑膜撕裂的存在、修复方法以及患者的结局。
共回顾了 3043 例 PSF，94 例患者（总体发生率为 3.3%）共发现 99 例硬脑膜撕裂。平均随访时间为 35.7 个月（0.1-142.5 个月）。当明确硬脑膜撕裂的原因时，69%发生在暴露过程中，5%发生在椎弓根螺钉置入过程中，4%发生在截骨过程中，2%发生在植入物取出过程中，2%发生在鞘内注射吗啡过程中。初次 PSF 中硬脑膜撕裂的发生率明显低于翻修 PSF 手术（2.6% vs. 6.2%，p<0.05）。86.9%的硬脑膜撕裂在术中得到修复和/或密封，而 13.1%的硬脑膜撕裂自行愈合。13.1%的患者出现术后头痛，平均 7.6 天缓解。有医嘱卧床休息和无医嘱卧床休息的患者头痛发生率无差异（p>0.99）。9.5%的患者发生术后感染，24.1%的患者需要进行翻修手术。
儿童脊柱手术中硬脑膜撕裂的发生率为 3.3%。尽管硬脑膜撕裂相关并发症发生，但大多数会随着时间的推移而缓解，并且在随访 2 年的患者中没有长期后遗症。
IV 级。
