RISK FACTORS FOR INCIDENTAL DUROTOMY DURING LUMBAR SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGYang ^1,2 ,  MAXinlong ² , JINHongbin ²

1. Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P. R. China;
2. Department of Orthopedics, Tianjin Hospital Tianjin, 300193, P. R. China;

Corresponding?author：

MAXinlong, Email: 13821776772@163.com

Keywords：

Incidental durotomy; Lumbar surgery; Risk factor

DOI：

10.7507/1002-1892.20150209

Video：

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Objective To evaluate the risk factors for incidental durotomy (ID) during lumbar surgery. Methods Eighty-six patients with ID and 86 patients with no ID (who were matched 1∶1 in surgeons and surgery time) were selected from 2 235 patients who underwent lumbar surgery between January 2010 and December 2012. The gender, age, body mass index, history of smoking, alcoholism, nonsteroidal drug use, the etiology, lumbar surgery history, revision surgery, surgical approach, osteoporosis, diabetes, and surgical procedure were compared between 2 groups. Logistic regression analysis was applied to analyze the risk factors for ID. Results There was significant difference (P<0.05) in etiology, surgical approach, revision surgery, lumbar surgery history, and surgical procedure between patients with ID and patients with no ID, which were then included in multivariate analysis. Logistic regression analysis demonstrated that lumbar surgery history, revision surgery, and minimal invasive surgery were risk factors for ID during lumbar surgery (P<0.05). Conclusion Lumbar surgery history, revision surgery, and minimal invasive surgery were risk factors for ID during lumbar surgery, thus surgery for patients with the above histories should be carefully performed to prevent ID.

Citation： YANGYang, MAXinlong, JINHongbin. RISK FACTORS FOR INCIDENTAL DUROTOMY DURING LUMBAR SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(8): 969-971. doi: 10.7507/1002-1892.20150209 Copy

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2.	Str?mqvist F,J?nsson B,Str?mqvist B,et al.Dural lesions in decompression for lumbar spinal stenosis:incidence,risk factors and effect on outcome.Eur Spine J,2012,21(5):825-828.
3.	Radcliff KE,Sidhu GD,Kepler CK,et al.Complications of flat bedrest following incidental dural repair.J Spinal Disord Tech,2013.[Epub ahead of print].
4.	Pechlivanis I,Kuebler M,Harders A,et al.Perioperative complication rate of lumbar disc microsurgery depending on the surgeon's level of training.Cent Eur Neurosurg,2009,70(3):137-142.
5.	Jankowitz BT,Atteberry DS,Gerszten PC,et al.Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery.Eur Spine J,2009,18(8):1169-1174.
6.	Teli M,Lovi A,Brayda-Bruno M,et al.Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy.Eur Spine J,2010,19(3):443-450.
7.	Tafazal SI,Sell PJ.Incidental durotomy in lumbar spine surgery:incidence and management.Eur Spine J,2005,14(3):287-290.
8.	McMahon P,Dididze M,Levi AD.Incidental durotomy after spinal surgery:a prospective study in an academic institution.J Neurosurg Spine,2012,17(1):30-36.
9.	任大江,張興勝,張志成,等.老年腰椎椎管狹窄癥患者術中硬膜囊撕裂位置及術中術后處理對策.脊柱外科雜志,2014,12(5):266-268.
10.	Sin AH,Caldito G,Smith D,et al.Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery.J Neurosurg Spine,2006,5(3):224-227.
11.	張志平,郭昭慶,孫垂國,等.退變性腰椎疾患后路減壓術后腦脊液漏的相關因素分析及處理.中國脊柱脊髓雜志,2014,24(10):906-911.
12.	孟陽,沈彬,張琰,等.腰椎后路減壓融合術并發腦脊液漏的多因素分析.中國脊柱脊髓雜志,2013,23(4):330-334.
13.	Kshettry VR,Benzel EC.Interpreting incidental durotomy rates in minimally invasive versus traditional techniques in retrospective studies:a word of caution.World Neurosurg,2015,83(3):311-312.
14.	McAfee PC,Phillips FM,Andersson G,et al.Minimally invasive spine surgery.Spine (Phila Pa 1976),2010,35(26 Suppl):S271-273.
15.	Youssef JA,McAfee PC,Patty CA,et al.Minimally invasive surgery:lateral approach interbody fusion:results and review.Spine (Phila Pa 1976),2010,35(26 Suppl):S302-311.
16.	Pimenta L,Oliveira L,Schaffa T,et al.Lumbar total disc replacement from an extreme lateral approach:clinical experience with a minimum of 2 years'follow-up.J Neurosurg Spine,2011,14(1):38-45.
17.	Regev GJ,Salame K,Behrbalk E,et al.Minimally invasive transforaminal,thoracic microscopic discectomy:technical report and preliminary results and complications.Spine J,2012,12(7):570-576.
18.	Smith ZA,Fessler RG.Paradigm changes in spine surgery:evolution of minimally invasive techniques.Nat Rev Neurol,2012,8(8):443-450.

1. Khan MH,Rihn J,Steele G,et al.Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery:a review of 3,183 consecutive degenerative lumbar cases.Spine (Phila Pa 1976),2006,31(22):2609-2613.
2. Str?mqvist F,J?nsson B,Str?mqvist B,et al.Dural lesions in decompression for lumbar spinal stenosis:incidence,risk factors and effect on outcome.Eur Spine J,2012,21(5):825-828.
3. Radcliff KE,Sidhu GD,Kepler CK,et al.Complications of flat bedrest following incidental dural repair.J Spinal Disord Tech,2013.[Epub ahead of print].
4. Pechlivanis I,Kuebler M,Harders A,et al.Perioperative complication rate of lumbar disc microsurgery depending on the surgeon's level of training.Cent Eur Neurosurg,2009,70(3):137-142.
5. Jankowitz BT,Atteberry DS,Gerszten PC,et al.Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery.Eur Spine J,2009,18(8):1169-1174.
6. Teli M,Lovi A,Brayda-Bruno M,et al.Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy.Eur Spine J,2010,19(3):443-450.
7. Tafazal SI,Sell PJ.Incidental durotomy in lumbar spine surgery:incidence and management.Eur Spine J,2005,14(3):287-290.
8. McMahon P,Dididze M,Levi AD.Incidental durotomy after spinal surgery:a prospective study in an academic institution.J Neurosurg Spine,2012,17(1):30-36.
9. 任大江,張興勝,張志成,等.老年腰椎椎管狹窄癥患者術中硬膜囊撕裂位置及術中術后處理對策.脊柱外科雜志,2014,12(5):266-268.
10. Sin AH,Caldito G,Smith D,et al.Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery.J Neurosurg Spine,2006,5(3):224-227.
11. 張志平,郭昭慶,孫垂國,等.退變性腰椎疾患后路減壓術后腦脊液漏的相關因素分析及處理.中國脊柱脊髓雜志,2014,24(10):906-911.
12. 孟陽,沈彬,張琰,等.腰椎后路減壓融合術并發腦脊液漏的多因素分析.中國脊柱脊髓雜志,2013,23(4):330-334.
13. Kshettry VR,Benzel EC.Interpreting incidental durotomy rates in minimally invasive versus traditional techniques in retrospective studies:a word of caution.World Neurosurg,2015,83(3):311-312.
14. McAfee PC,Phillips FM,Andersson G,et al.Minimally invasive spine surgery.Spine (Phila Pa 1976),2010,35(26 Suppl):S271-273.
15. Youssef JA,McAfee PC,Patty CA,et al.Minimally invasive surgery:lateral approach interbody fusion:results and review.Spine (Phila Pa 1976),2010,35(26 Suppl):S302-311.
16. Pimenta L,Oliveira L,Schaffa T,et al.Lumbar total disc replacement from an extreme lateral approach:clinical experience with a minimum of 2 years'follow-up.J Neurosurg Spine,2011,14(1):38-45.
17. Regev GJ,Salame K,Behrbalk E,et al.Minimally invasive transforaminal,thoracic microscopic discectomy:technical report and preliminary results and complications.Spine J,2012,12(7):570-576.
18. Smith ZA,Fessler RG.Paradigm changes in spine surgery:evolution of minimally invasive techniques.Nat Rev Neurol,2012,8(8):443-450.

Chinese Journal of Reparative and Reconstructive Surgery

RISK FACTORS FOR INCIDENTAL DUROTOMY DURING LUMBAR SURGERY

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