Oshima Yasushi, Nakamoto Hideki, Doi Toru, Miyahara Junya, Sato Yusuke, Tonosu Juichi, Tachibana Naohiro, Urayama Daiki, Saiki Fumiko, Anno Masato, Okamoto Naoki, Sasaki Katsuyuki, Hirai Shima, Oshina Masahito, Sugita Shurei, Masuda Kazuhiro, Tanaka Sakae
Department of Orthopaedic Surgery, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.
Department of Orthopaedic Surgery, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; University of Tokyo Spine Group (UTSG), 113-0033, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.
Spine J. 2025 Jan;25(1):91-98. doi: 10.1016/j.spinee.2024.09.020. Epub 2024 Sep 26.
Incidental dural tear (DT) during cervical spine surgery is a feared complication. However, its impact on patient-reported outcomes (PROs) remains unclear.
To determine the influence of DTs on PROs 1 year after cervical spine surgery.
Retrospective cohort.
Patients undergoing elective cervical spine surgery for cervical spondylosis, ossification of the posterior longitudinal ligament (OPLL), and cervical disc herniation.
Analysis included patients' characteristics, perioperative complications, and PROs both preoperatively and at 1 year postoperatively.
This study enrolled consecutive patients who underwent elective cervical spine surgery at 13 high-volume spine centers. All patients were required to complete questionnaires both preoperatively and 1 year postoperatively, which included PROs such as numerical rating scales of pain or dysesthesia for each part of the body, Neck Disability Index NDI, and Core Outcome Measures Index. Patients were divided into 2 groups based on the presence (DT+) or absence (DT-) of dural injury. Comparisons were made regarding patient background, perioperative complications, and pre and postoperative PROs. Propensity score matching was also utilized to adjust for patient background, and further comparisons were made regarding complication rates and PROs.
Out of 2,704 patients, dural tears were identified in 97 (3.6%) cases. The DT+ group had a significantly higher proportion of fixation surgeries, upper cervical surgeries, OPLL, and revision surgeries. Perioperative complications were significantly higher in the DT+ group, including intraoperative nerve damage, postoperative paralysis, surgical site infections (SSI), and cerebrovascular complications. Outcomes collected from 2,163 patients (79.9%) revealed significantly more severe neck and upper limb pain in the DT+ group. After propensity score matching, significant differences persisted in postoperative paralysis and SSI in the DT+ group, but no significant differences were observed in PROs.
Patients with dural tears showed nearly equivalent postoperative outcomes at 1 year following cervical spine surgery compared to those without dural tears. However, the incidence of perioperative complications was higher, emphasizing the need for careful management.
颈椎手术中意外硬脑膜撕裂（DT）是一种令人担忧的并发症。然而，其对患者报告结局（PROs）的影响仍不明确。
确定颈椎手术后1年硬脑膜撕裂对患者报告结局的影响。
回顾性队列研究。
因颈椎病、后纵韧带骨化症（OPLL）和颈椎间盘突出症接受择期颈椎手术的患者。
分析包括患者特征、围手术期并发症以及术前和术后1年的患者报告结局。
本研究纳入了13家大型脊柱中心接受择期颈椎手术的连续患者。所有患者术前和术后1年都需要完成问卷调查，其中包括身体各部位疼痛或感觉异常的数字评分量表、颈部功能障碍指数（NDI）和核心结局指标指数等患者报告结局。根据是否存在硬脑膜损伤将患者分为两组（DT+组和DT-组）。对患者背景、围手术期并发症以及术前和术后的患者报告结局进行比较。还采用倾向评分匹配来调整患者背景，并对并发症发生率和患者报告结局进行进一步比较。
在2704例患者中，97例（3.6%）发现硬脑膜撕裂。DT+组固定手术、上颈椎手术、OPLL和翻修手术的比例显著更高。DT+组围手术期并发症显著更高，包括术中神经损伤、术后瘫痪、手术部位感染（SSI）和脑血管并发症。从2163例患者（79.9%）收集的结局显示，DT+组颈部和上肢疼痛明显更严重。倾向评分匹配后，DT+组术后瘫痪和SSI仍存在显著差异，但在患者报告结局方面未观察到显著差异。
与无硬脑膜撕裂的患者相比，硬脑膜撕裂患者在颈椎手术后1年的术后结局几乎相当。然而，围手术期并发症的发生率更高，这强调了谨慎管理的必要性。
