Comparison of Symptomatic Cerebral Spinal Fluid Leak Between Patients Undergoing Minimally Invasive versus Open Lumbar Foraminotomy, Discectomy, or Laminectomy
Comparison of Symptomatic Cerebral Spinal Fluid Leak Between Patients Undergoing Minimally Invasive versus Open Lumbar Foraminotomy, Discectomy, or Laminectomy
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DOI：
10.1016/j.wneu.2013.11.012
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发表时间：
2014-03-01
影响因子：
2
通讯作者：
Fessler, Richard G.
中科院分区：
文献类型：
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作者：
Wong, Albert P.;Shih, Patrick;Fessler, Richard G.
目的：微创脊柱手术(MISH)与开放手术相比，对于接受1个或2个节段的椎间盘切除、椎间孔切开或椎板切除的患者，具有相似的长期结果。然而，这两种技术的脑脊液漏出率在文献中还没有很好的确定。本研究旨在比较开放腰椎孔切开术、腰椎间盘摘除或椎板切除术与类似的漏诊入路的脑脊液漏的发生率和临床影响。方法：共有863例患者接受了1或2个节段的腰椎间盘摘除、椎板切开或椎板切除术的脑脊液漏的评估。评估的变量包括手术时间、出血量、脑脊液漏、住院天数、腰椎引流天数、术后平床休息天数和术后干预。统计分析包括单因素分析(t检验、方差分析、优势比、X~2检验)和双因素分析(Logistic回归)。结果：漏诊组发生脑脊液漏15例(4.7%)，开放组发生脑脊液漏49例(9.0%)。开放组中有8名患者需要腰椎引流，而未开腹组则为0例。开放组中有12名患者因持续性脑脊液漏而需要再次手术，而未接受手术组则为零。接受开放脊柱手术的患者发生脑脊液漏的可能性是对照组的2倍(优势比=2.3，95%可信区间=1.2至3.7，P=0.01)。接受未命中手术的患者修补脑脊液漏的再手术率显著降低(开放手术占开放性脑脊液漏病例的25%，未修复脑脊液再手术率为0%，P<0.01)。结论：在本研究中，未经手术入路与开放手术入路相比，脑脊液漏的发生率显著降低。此外，开放手术中的脑脊液漏更有可能需要腰椎引流或再次手术来修复十二指肠切开。
OBJECTIVE: Minimally invasive spine surgery (MISS) techniques have similar long-term outcomes compared to open surgery for patients undergoing 1- or 2-level discectomy, foraminotomy, or laminectomy. However, the rate of cerebrospinal fluid (CSF) leaks with both techniques has not been well established in the literature. This study sought to compare the rate and clinical impact of CSF leak in open lumbar foraminotomy, discectomy, or laminectomy with comparable MISS approaches.METHODS: A total of 863 patients undergoing 1- or 2-level discectomy, foraminotomy, or laminectomy by either MISS an open technique were evaluated for CSF leaks. Variables assessed included operative time, blood loss, CSF leaks, hospital stay, days with lumbar drain, days of postoperative flat bed rest, and postoperative intervention. Statistical analyses include univariate analysis (Student t test, analysis of variance, odds ratio, chi(2)) and bivariate analysis (logistic regression).RESULTS: In the MISS group there were 15 CSF leaks (4.7%), and 49 CSF leaks (9.0%) in the open group. Eight patients in the open group required lumbar drainage, compared to zero patients in the MISS group. Twelve patients required reoperation for persistent CSF leak in the open group, compared to zero patients in the MISS group. Patients undergoing open spine surgery were 2 times more likely to have a CSF leak (odds ratio = 2.3, 95% confidence interval = 1.2 to 3.7, P =.01). Patients undergoing MISS had significantly lower reoperation rates for CSF leak repairs (open = 25% of open CSF leak cases, MISS = 0%, P < .01).CONCLUSIONS: In this study, there was a statistically significant decreased rate of CSF leak between an MISS approach and an open surgical approach. Furthermore, CSF leaks in open surgery have a higher probability of requiring lumbar drainage or reoperation to repair the durotomy.