Huan Zhendong, Lei Linkai
Department of Trauma Orthopedics, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai city, Shandong province, China.
Department of Spine Surgery, Yantaishan Hospital, 10087, Science and Technology Avenue, Laishan District, Yantai city, Shandong province, 264008, China.
J Orthop Surg Res. 2025 Apr 15;20(1):378. doi: 10.1186/s13018-025-05792-2.
Incidental durotomy (ID) during spinal surgery is common during spinal surgery. This study aimed to determine whether intraoperative ID affects the perioperative and long-term clinical outcomes in patients with degenerative lumbar disease (DLD) undergoing posterior open lumbar interbody fusion (POLIF).
This multicenter observational study was conducted at two spinal centers between January 2020 and December 2022. The patients were divided into ID and non-ID groups according to whether ID occurred intraoperatively. Primary outcome measure was the length of hospital stay (LOS), while secondary outcome measures were 30-day readmission rate; hospital costs; postoperative visual analog scale (VAS) scores for low back pain (LBP) and leg pain (LP) at 1 day, 3, 7, and 15 days, 1 month, 3, 6, and 12 months; and Oswestry Disability Index (ODI) at 1 month, 3, 6, and 12 months.
Intraoperative ID occurred in 8.7% (36/415) patients. LOS, operative time, estimated blood loss, 30-day readmission rate, and hospital costs were significantly higher in the ID group. On average, the LOS increased by 2.9 days and hospital costs increased by 4800.2 yuan per patient. The ID group had significantly higher baseline VAS scores for LBP 15 days and 1 month postoperatively than the non-ID group. The ODI was significantly higher in the ID group than in the non-ID group 1 month postoperatively. No significant differences were noted in the VAS scores and ODI between the two groups at 3, 6, and 12 months postoperatively. Finally, we found that a higher BMI (P = 0.035, OR: 1.195, 95%CI: 1.012-1.412) and revision surgery (P = 0.022, OR: 2.901, 95%CI: 1.164-7.233) were risk factors for intraoperative ID.
Although ID does not significantly affect the long-term outcomes in patients with DLD after POLIF, it can lead to poorer perioperative clinical outcomes. Lumbar fusion surgery should be performed meticulously to minimize the incidence of intraoperative ID.
脊柱手术中意外硬脊膜切开术（ID）在脊柱手术中很常见。本研究旨在确定术中ID是否会影响接受后路开放性腰椎椎间融合术（POLIF）的退变性腰椎疾病（DLD）患者的围手术期和长期临床结局。
本多中心观察性研究于2020年1月至2022年12月在两个脊柱中心进行。根据术中是否发生ID将患者分为ID组和非ID组。主要结局指标是住院时间（LOS），次要结局指标是30天再入院率；住院费用；术后1天、3天、7天、15天、1个月、3个月、6个月和12个月时的下腰痛（LBP）和腿痛（LP）的视觉模拟量表（VAS）评分；以及1个月、3个月、6个月和12个月时的Oswestry功能障碍指数（ODI）。
8.7%（36/415）的患者发生术中ID。ID组的LOS、手术时间、估计失血量、30天再入院率和住院费用显著更高。平均而言，每位患者的LOS增加2.9天，住院费用增加4800.2元。ID组术后15天和1个月时LBP的基线VAS评分显著高于非ID组。ID组术后1个月时的ODI显著高于非ID组。术后3个月、6个月和12个月时，两组之间的VAS评分和ODI无显著差异。最后，我们发现较高的体重指数（P = 0.035，OR：1.195，95%CI：1.012 - 1.412）和翻修手术（P = 0.022，OR：2.901，95%CI：1.164 - 7.233）是术中ID的危险因素。
尽管ID对POLIF术后DLD患者的长期结局没有显著影响，但它会导致较差的围手术期临床结局。腰椎融合手术应精心进行，以尽量减少术中ID的发生率。
