The frequency and etiology of intraoperative dural tears in 110 predominantly geriatric patients undergoing multilevel laminectomy with noninstrumented fusions
The frequency and etiology of intraoperative dural tears in 110 predominantly geriatric patients undergoing multilevel laminectomy with noninstrumented fusions
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DOI：
10.1097/bsd.0b013e31802dabd2
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发表时间：
2007-07-01
影响因子：
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通讯作者：
Epstein, Nancy E.
中科院分区：
文献类型：
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作者：
Epstein, Nancy E.
研究设计：回顾性分析硬脑膜撕裂（DT）的频率和病因，定义为术中意外的硬脑膜切开，发生在110例多节段椎板切除术合并无器械融合的老年患者中。目的：了解老年DT患者的发病频率和病因。背景资料总结：老年患者DT发生的频率和病因并没有很好的文献记载。方法：回顾性分析110例有/无DT患者的临床（包括合并症）、神经诊断、手术方式和36个短期结局（术前、术后3、6、12个月进行问卷调查）。结果：10例患者中10例发生术中DT。这些患者通常年龄较大（有瘘管的平均年龄为74岁，无瘘管的平均年龄为69岁），女性比例较高（90%比76%），并且接受了更广泛的椎板切除术（5.5比5.0水平）和非器械融合（1.8比1.6水平）。似乎有三个因素导致了DT。10例DT患者均有明显的黄韧带骨化（OYL），其中3例延伸至硬脑膜并穿过硬脑膜。100例无DT的患者中，57例表现为中度/肥大的黄韧带，22例表现为明显的OYL。10例DT患者中有5例观察到滑膜囊肿有明显的OYL，而100例非DT患者中只有8例观察到滑膜囊肿。先前的手术疤痕，最初被认为是DT的主要因素，在10例DT患者中只有2例（也有明显的OYL）被发现，而没有DT的患者中有10%被发现。简表36结果数据显示，两组患者术后第一年的4或5项健康量表均有改善。结论：110例接受多节段椎板切除术和无器械融合的患者中，有10例发生了意外的偶发DT，原因是OYL延伸至/穿过硬脑膜（3例），术后疤痕/标记OYL（2例）和滑膜囊肿/标记OYL（5例）。
Study Design: A retrospective analysis of the frequency and etiology of dural tears (DT), defined as an unintended incidental intraoperative durotomy, occurring in 110 predominantly geriatric patients undergoing multilevel laminectomies with noninstrumented fusions.Objective: To document the frequency and etiology of DT occurring in these older patients.Summary of Background Data: The frequency and etiology of DT occurring in older patients are not well documented.Methods: The clinical (including comorbidities), neurodiagnostic, surgical procedures, and Short-Form 36 outcomes (questionnaires administered preoperatively, and 3, 6, 12 mo postoperatively) were retrospectively analyzed for these 110 patients with/without DT.Results: Intraoperative DT occurred in 10 of I 10 patients. These patients were typically older (average 74 y with fistulas vs. 69 y old without fistulas), included a higher percentage of females (90% vs. 76%), and had undergone somewhat more extensive laminectomies (5.5 vs. 5.0 levels) with noninstrumented fusions (1.8 vs. 1.6 levels). Three factors seemed to contribute to DT. Marked ossification of the yellow ligament (OYL), documented in all 10 patients with DT, extended to and through the dura in 3 patients. For the 100 patients without DT, 57 exhibited moderate/hypertrophied yellow ligament and 22 showed marked OYL. Synovial cysts with marked OYL were observed in 5 of 10 patients with DT, whereas only 8 of 100 without DT had synovial cysts. Prior surgical scar, originally anticipated to be a major contributing factor to DT, was found in only 2 of 10 patients with DT (also with marked OYL) compared with 10% without DT. Short-Form 36 outcome data revealed improvement on 4 or 5 Health Scales over the first postoperative year for both populations.Conclusions: Ten of 110 patients undergoing multilevel laminectomies and noninstrumented fusions developed unintended incidental DT attributed to OYL extending to/through the dura (3 patients), postoperative scar/marked OYL (2 patients), and synovial cysts/marked OYL (5 patients).