SPORT: Does incidental durotomy affect longterm outcomes in cases of spinal stenosis?
SPORT: Does incidental durotomy affect longterm outcomes in cases of spinal stenosis?
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DOI：
10.1227/01.neu.0000462078.58454.f4
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发表时间：
2015-03-01
期刊：
影响因子：
4.8
通讯作者：
Weinstein, James N
中科院分区：
文献类型：
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作者：
Desai, Atman;Ball, Perry A;Weinstein, James N
背景：在腰椎管狭窄症的手术中，意外硬脊膜切开术是一种常见的遭遇。硬脊膜切开术对长期预后的影响仍然存在争议。目的：确定硬脊膜切开术对脊柱患者预后研究试验（SPORT）中患者长期预后的影响。方法：SPORT队列受试者确诊为椎管狭窄，无相关脊椎滑脱，接受标准、首次开放性椎板减压术，伴或不伴融合，在美国11个州的13家脊柱诊所，从基线开始，分别在6周、3个月、6个月、12个月和每年进行随访。对该前瞻性收集数据库中的患者数据进行了审查。截至2009年5月，所有分析患者的平均随访时间为43.8个月。其中37例患者（9%）进行了意外硬脊膜切开术。在年龄、性别、种族、体重指数、吸烟、糖尿病和高血压的患病率、减压节段、减压节段数量或是否进行额外融合方面，未观察到有或无硬脊膜切开术的显著差异。硬脊膜切开术组的手术时间、手术失血量和住院时间显著增加。然而，神经根损伤的发病率，死亡率，额外的手术，或主要结果（简表-36躯体疼痛或身体功能评分或奥斯韦斯特里残疾指数）在每年随访4 years.CONCLUSIONS：偶然硬脊膜切开术在首次腰椎椎板切除术椎管狭窄症并没有影响长期的结果在受影响的患者。
BACKGROUND: Incidental durotomy is a familiar encounter during surgery for lumbar spinal stenosis. The impact of durotomy on long-term outcomes remains a matter of debate.OBJECTIVE: To determine the impact of durotomy on the long-term outcomes of patients in the Spine Patient Outcomes Research Trial (SPORT).METHODS: The SPORT cohort participants with a confirmed diagnosis of spinal stenosis, without associated spondylolisthesis, undergoing standard, first-time, open decompressive laminectomy, with or without fusion, were followed up from baseline at 6 weeks, and 3, 6, and 12 months and yearly thereafter at 13 spine clinics in 11 US states. Patient data from this prospectively gathered database were reviewed. As of May 2009, the mean follow-up among all analyzed patients was 43.8 months.RESULTS: Four hundred nine patients underwent first-time open laminectomy with or without fusion. Thirty-seven of these patients (9%) had an incidental durotomy. No significant differences were observed with or without durotomy in age; sex; race; body mass index; the prevalence of smoking, diabetes mellitus, and hypertension; decompression level; number of levels decompressed; or whether an additional fusion was performed. The durotomy group had significantly increased operative duration, operative blood loss, and inpatient stay. There were, however, no differences in incidence of nerve root injury, mortality, additional surgeries, or primary outcomes (Short Form-36 Bodily Pain or Physical Function scores or Oswestry Disability Index) at yearly follow-ups to 4 years.CONCLUSIONS: Incidental durotomy during first-time lumbar laminectomy for spinal stenosis did not impact long-term outcomes in affected patients.