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Wang H, Wang Y, Jiang Z, Zhang W. Case Report: Bacterial meningitis due to cerebrospinal fluid leakage following unilateral biportal endoscopic spinal surgery: a cautionary tale. Front Surg 2024; 11:1301905. [PMID: 38516395 PMCID: PMC10954800 DOI: 10.3389/fsurg.2024.1301905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Unilateral biportal endoscopic spinal surgery (UBE) is a rapidly growing surgical method and has attracted much interest recently. The most common complication of this technique is cerebrospinal fluid (CSF) leakage due to intraoperative dural tears. There have been no reports of bacterial meningitis due to dural tears in UBE surgery and its treatment and prevention. We reported a 47 year-old man with CSF due to an intraoperative dural tear. A drainage tube was routinely placed and removed on the fourth day after surgery, resulting in fever and headache on the fifith postoperative day. Blood and CSF cultures showed Klebsiella pneumoniae infection, and with lumbar drainage and appropriate antibiotics based on sensitivity tests, the patient's fever and headache were effectively relieved. This case report suggests the importance of prolonged drainage tube placement, adequate drainage, careful intraoperative separation to avoid dural tears, and effective sensitive antibiotic therapy.
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Affiliation(s)
| | | | - Zhensong Jiang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wen Zhang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Faldini C, Barile F, D'Antonio G, Rinaldi A, Manzetti M, Viroli G, Vita F, Traversari M, Cerasoli T, Ruffilli A. Incidental dural tears do not affect the overall patients' reported outcome of spine surgery at long-term follow-up: results of a systematic review. Musculoskelet Surg 2024; 108:47-61. [PMID: 36877336 DOI: 10.1007/s12306-023-00777-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 03/07/2023]
Abstract
To conduct a systematic review of the literature in order to establish if there is an overall adverse effect of accidental durotomy on the long-term patients' reported outcome after elective spine surgery. A systematic literature search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data about pre- and postoperative clinical outcomes of patients with accidental durotomy and patients without were extracted and analysed. After screening, eleven studies were included with a total of 80,541 patients. About 4112 of these patients (5.10%) had incidental dural tear. When comparing patients with dural tear to patients without, 9/11 authors found no patients' reported differences at last follow-up. One author found a slightly worse VAS back pain in dural tear patients, and another author found inferior SF-36 and ODI scores in dural tear patients (both below minimal clinically important difference). Accidental dural tear did not have a significant adverse effect on clinical outcome of elective spine surgery. More studies are needed to better demonstrate this result.
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Affiliation(s)
- C Faldini
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - F Barile
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - G D'Antonio
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - A Rinaldi
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - M Manzetti
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - G Viroli
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - F Vita
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - M Traversari
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136.
| | - T Cerasoli
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - A Ruffilli
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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3
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Greil ME, Bergquist J, Kashlan ON, Kwon WK, Durfy S, Hofstetter CP. Incidence and management of dural tears in full-endoscopic unilateral laminotomies for bilateral lumbar decompression. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2889-2895. [PMID: 37264093 DOI: 10.1007/s00586-023-07749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To report incidence of dural lacerations in lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) and to describe patient outcomes following a novel full-endoscopic bimanual durotomy repair. METHODS Retrospective review of prospectively collected database including 5.5 years of single surgeon experience with LE-ULBD. Patients with no durotomy were compared with patients who experienced intraoperative durotomy, including demographics, ASA score, prior surgery, number of levels treated, procedure time, hospital length of stay (LOS), visual analogue scale, perioperative complications, revision surgeries, use of analgesics, and Oswestry Disability Index (ODI). RESULTS In total, 13/174 patients (7.5%) undergoing LE-ULBD experienced intraoperative durotomy. No significant differences in demographic, clinical or operative variables were identified between the 2 groups. Sustaining a durotomy increased LOS (p = 0.0019); no differences in perioperative complications or rate of revision surgery were identified. There was no difference in minimally clinically important difference for ODI between groups (65.6% for no durotomy versus 55.6% for durotomy, p = 0.54). CONCLUSION In this cohort, sustaining a durotomy increased LOS but, with accompanying intraoperative repair, did not significantly affect rate of complications, revision surgery or functional outcomes. Our method of bimanual endoscopic dural repair provides an effective approach for repair of dural lacerations in interlaminar ULBD cases.
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Affiliation(s)
- Madeline E Greil
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA
| | - Julia Bergquist
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Woo-Keun Kwon
- Department of Neurosurgery, College of Medicine, Korea University Guro Hospital, Korea University, Seoul, Republic of Korea
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA.
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Chen Z, Zhou H, Wang X, Liu Z, Liu W, Luo J. Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review. World Neurosurg 2023; 170:e371-e379. [PMID: 36368457 DOI: 10.1016/j.wneu.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND In recent years, unilateral biportal endoscopic spinal surgery has been used for the treatment of lumbar spinal stenosis with good results. Some investigators counted the total incidence of complications in unilateral biportal endoscopic surgery for lumbar spinal stenosis, but none have analyzed the incidence of specific complications. The present study further counted the incidence of specific complications and gave the possible causes of the complications. METHODS English databases including PubMed were searched to collect relevant literature on unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis. The inquiry period is from January 1, 2015, to July 1, 2022. The literature was screened, information extracted, and risk of bias evaluated by the researchers, followed by Meta analysis using R4.2.1 and RStudio statistical software. RESULTS In total, we included 14 studies involving 707 patients. The included studies were retrospective case series, The results of the single-arm rate meta-analysis showed that the total complication rate of unilateral biportal endoscopic surgery treatment of lumbar spinal stenosis was 8.1% (95% confidence interval [CI] [0.060; 0.103]); of which, the highest incidence of dural tear was 4.5% (95% CI [0.030; 0.064]), the incidence of symptomatic postoperative spinal epidural hematoma was approximately 1.1% (95% CI [0.001; 0.027]), the incidence of incomplete decompression was 2.0% (95% CI [0.007; 0.038]), the incidence of transient palsy was 2.6% (95% CI [0.005; 0.057]). CONCLUSIONS The incidence of total complications of unilateral biportal endoscopic surgery for lumbar spinal stenosis was 8.1%, dural tear remained a major complication with an incidence of 4.5%, incomplete decompression was 2.0%, transient palsy was 2.6%, and, unexpectedly, symptomatic postoperative spinal epidural hematoma was only 1.1%.
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Affiliation(s)
- Zhaoyuan Chen
- First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China; Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huaqiang Zhou
- First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China; Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xuhua Wang
- First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China; Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Zhenxing Liu
- First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China; Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Wuyang Liu
- First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China; Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Jiaquan Luo
- First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China; Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.
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Sheng Y, Li J, Chen L, Geng M, Fen J, Sun S, Sun J. Delta large-channel technique versus microscopy-assisted laminar fenestration decompression for lumbar spinal stenosis: a one-year prospective cohort study. BMC Musculoskelet Disord 2023; 24:43. [PMID: 36653778 PMCID: PMC9850816 DOI: 10.1186/s12891-023-06143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE When it comes to treating lumbar spinal stenosis (LSS), a procedure known as microscope-assisted fenestration decompression has expediently become the gold standard. With the advancement of spinal endoscopy, the Delta large-channel approach has shown promising clinical outcomes in the management of lumbar spinal stenosis. However, case studies of this method being used to treat lumbar spinal stenosis are still uncommon. The purpose of this research was to examine how well microscopy-assisted laminectomy and the Delta large-channel approach work in treating LSS in the clinic. METHODS From May 2018 to June 2020, 149 patients diagnosed with LSS were divided into 80 patients in Delta large-channel technique groups (FE group) and 69 patients in microscope groups (Micro group). Lower back and lower limb pain were measured using the visual analogue scale (VAS-LBP and VAS-LP), while lower limb numbness was evaluated using the 11-point numerical rating scale (NRS-LN); modified Oswestry Disability Index (ODI) was used to evaluate the quality of life, and modified MacNab criteria were used to assess the clinical efficacy before surgery and at one week, three months, six months, and 12 months after surgery. All patients had single-level lumbar spinal stenosis, and clinical data such as hospital stay, operation time, intraoperative blood loss were statistically analyzed. RESULTS Finally, 111 patients (62 in FE group and 49 in Micro group) completed follow-up. Compared with preoperative results, postoperative VAS-LBP, VAS-LP, NRS-LN score and modified ODI score were significantly improved in 2 groups (P < 0.05), but there was no significant difference in postoperative follow-up at each time point (P > 0.05), Except 1 week after surgery, VAS-LBP in FE group was lower than that in Micro group (P < 0.05). It is noteworthy that the FE group had a shorter hospital stay, less intraoperative blood loss, and a quicker time of getting out of bed when compared with the microscope group,but the operation time was just the opposite (P < 0.05). The excellent and good rate was 83.87% in FE group and 85.71% in Micro group (P > 0.05). CONCLUSIONS Both microscope-assisted laminar fenestration decompression and Delta large-channel procedures provide satisfactory treatment outcomes, however the Delta large-channel approach has some potential advantages for the treatment of LSS, including quicker recovery and sooner reduced VAS-LBP. Long-term consequences, however, will necessitate additional follow-up and research.
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Affiliation(s)
- Yuehang Sheng
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Jing Li
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Lei Chen
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Minghao Geng
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Jing Fen
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Shaodong Sun
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Jianhua Sun
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
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Masuda S, Fukasawa T, Takeuchi M, Fujibayashi S, Otsuki B, Murata K, Shimizu T, Matsuda S, Kawakami K. Reoperation Rates of Microendoscopic Discectomy Compared With Conventional Open Lumbar Discectomy: A Large-database Study. Clin Orthop Relat Res 2023; 481:145-154. [PMID: 35838602 PMCID: PMC9750527 DOI: 10.1097/corr.0000000000002322] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/23/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Microendoscopic discectomy for lumbar disc herniation has been shown to be as effective as traditional microdiscectomy or open discectomy in terms of clinical outcomes such as pain relief, and it is less invasive. Nevertheless, the reoperation rate for microendoscopic discectomy compared with microdiscectomy or open discectomy remains unclear, possibly due to difficulties in conducting follow-up of sufficient duration and in obtaining information about reoperation in other facilities. QUESTIONS/PURPOSES (1) What is the rate of reoperation after microendoscopic discectomy for primary lumbar disc herniation on a large scale at a median of 4 years postoperatively? (2) Is there any difference in revision rate at a median of 4 years and within 90 days postoperatively based on surgical method? METHODS We conducted a retrospective, comparative study of adult patients who underwent microendoscopic discectomy or microdiscectomy or open discectomy for lumbar disc herniation from April 2008 to October 2017 and who were followed until October 2020 using a commercially available administrative claims database from JMDC Inc. This claims-based database provided information on individual patients collected across multiple hospitals, which improved the accuracy of postoperative reoperation rates. We included 3961 patients who received microendoscopic discectomy or microdiscectomy or open discectomy between April 2008 and October 2017 in the JMDC claims database. After applying exclusion criteria, 50% (1968 of 3961) of patients were eligible for this study. Propensity score-weighted analyses were conducted in 646 patients in the microendoscopic discectomy group and in 1322 in the microdiscectomy or open discectomy group, with a median (IQR) of 4 years (3 to 6) of follow-up in both groups. Mean patient age was 42 ± 12 years in the microendoscopic discectomy group and 43 ± 12 years in the microdiscectomy or open discectomy group. Males accounted for 78% (505 of 646) of patients in the microendoscopic discectomy group and 79% (1050 of 1322) of patients in microdiscectomy or open discectomy group. The proportion of patients with diabetes mellitus in the microendoscopic discectomy group (10% [64 of 646]) was less than in the microdiscectomy or open discectomy group (15% [195 of 1322]). The primary outcome was Kaplan-Meier survivorship free from any type of additional lumbar spine surgery at a median of 4 years after the index surgery. The secondary outcome was survival probability using the Kaplan-Meier method with endpoints of any type of reoperation within 90 days after the index surgery. To determine which procedure had the higher revision rate, we conducted propensity score overlap weighting analysis, which controlled for potential confounding variables such as age, sex, comorbidities, and type of hospital as well as Cox proportional hazard models to estimate HRs and 95% confidence intervals (CIs). RESULTS The 5-year cumulative reoperation rate was 12% (95% CI 9% to 15%) in the microendoscopic discectomy group and 7% (95% CI 6% to 9%) in the microdiscectomy or open discectomy group. After controlling for potentially confounding variables like age, sex, and diabetes mellitus, the microendoscopic discectomy group had a higher reoperation risk than the microdiscectomy or open discectomy group (weighted HR 1.57 [95% CI 1.14 to 2.16]; p = 0.004). Within 90 days of the index surgery, after controlling for potentially confounding variables like age, sex, and diabetes mellitus, we found no difference between the microendoscopic discectomy group and microdiscectomy or open discectomy group in terms of risk of reoperation (weighted HR 1.38 [95% CI 0.68 to 2.79]; p = 0.38). CONCLUSION Given the higher reoperation risk with microendoscopic discectomy compared with microdiscectomy or open discectomy at a median of 4 years of follow-up, surgeons should select microdiscectomy or open discectomy, despite the current popularity of microendoscopic discectomy. The revision risk of microendoscopic discectomy compared with microdiscectomy or open discectomy in the long term remains unclear. Future large, prospective, multicenter cohort studies with long-term follow-up are needed to confirm the association between microendoscopic discectomy and risk of reoperation. LEVEL OF EVIDENCE Level Ⅲ, therapeutic study.
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Affiliation(s)
- Soichiro Masuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Ali R, Hagan MJ, Bajaj A, Alastair Gibson J, Hofstetter CP, Waschke A, Lewandrowski KU, Telfeian AE. IMPACT OF THE LEARNING CURVE OF PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY ON CLINICAL OUTCOMES: A SYSTEMATIC REVIEW. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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8
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Kong W, Du Q, Xin Z, Cao G, Liu D, Wei Y, Liao W. Percutaneous fully endoscopic surgical management of the ruptured epidural catheter: Rescue of the novice anesthesiologist from his dilemma. Front Surg 2022; 9:915133. [PMID: 36303856 PMCID: PMC9592838 DOI: 10.3389/fsurg.2022.915133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Epidural nerve block and analgesia are basic anesthetic techniques for anesthesia. Epidural catheter rupture and partial retention are adverse events and rare complications of epidural catheterization technique. The probability of occurrence when applied by novice doctors is high. Removal of the residual catheter by conventional surgery causes more trauma and bleeding, slows recovery, and may causes medical disputes. We hypothesized that percutaneous spinal endoscopy a safe and effective remediation technique. This study was to analyze the efficacy and safety of removing the residual dural catheter by a percutaneous full-endoscopic technique(PFET) and discuss the clinical technique and precautions. METHODS This was a retrospective analysis of 7 patients with ruptured epidural catheters treated in our department from October 2015 to October 2019 using the PFET to remove the remaining epidural catheter. The operation time, intraoperative bleeding volume, surgical complications, and neurological symptoms before and after surgery were recorded. The Self-Rating Anxiety Scale (SAS) was used to assess the anxiety level of the anesthesiologist and the patient before and after the catheter removal operation, and the postoperative low back pain VAS score was recorded. RESULTS The remaining epidural catheter was successfully removed from all 7 patients. The operation time was 54.14 ± 14.45 (32-78) minutes, and the intraoperative blood loss was 9.134 ± 3.078 (5-15) ml. There were no cases of dural damage, cerebrospinal fluid leakage, sensorimotor dysfunction of the lower limbs, or bowel dysfunction. The anxiety symptoms of the patient and the anesthesiologist disappeared after removal of the residual epidural catheter. The patients' postoperative back pain VAS score was 0 to 2 points. CONCLUSION PFET is a safe and effective minimally invasive technique for removing residual epidural catheters. It causes less trauma and less bleeding, allows a faster recovery. It does not affect the recovery of patients from other surgical operations and reduces both medical risks and medical costs. At the same time, it avoids or reduces the occurrence of medical disputes and eliminates the pressure on novice anesthesiologists regarding similar adverse events.
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Affiliation(s)
- Weijun Kong
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China,Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qian Du
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhijun Xin
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guangru Cao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China,Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dexing Liu
- Department of Anesthesia and Perioperative Care, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yiyong Wei
- Department of Anesthesia and Perioperative Care, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wenbo Liao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China,Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China,Correspondence: Wenbo Liao
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9
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Suzuki A, Nakamura H. Microendoscopic Lumbar Posterior Decompression Surgery for Lumbar Spinal Stenosis: Literature Review. Medicina (B Aires) 2022; 58:medicina58030384. [PMID: 35334560 PMCID: PMC8954505 DOI: 10.3390/medicina58030384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/13/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
Lumbar spinal stenosis (LSS) is a common disease in the elderly, mostly due to degenerative changes in the lumbar spinal complex. Decompression surgery is the standard surgical treatment for LSS. Classically, total laminectomy—which involves resection of the spinous process, entire laminae and medial facet—has been the standard decompression technique; however, it can cause post-surgical instability. To overcome this disadvantage, various minimally invasive techniques that preserve the stabilization structures of the spine have been developed, and surgeons have begun to re-evaluate decompression surgery from the standpoint of reduced invasiveness and cost. More than two decades have passed since the introduction of microendoscopic spine surgery, and studies continue to shed light on its advantages and limitations as new knowledge becomes available. This article is a narrative review of the available literature, along with authors’ experience, regarding the indications, surgical techniques, clinical outcomes, and limitations/complications of microendoscopic decompression for LSS.
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Ohtomo N, Nakamoto H, Miyahara J, Yoshida Y, Nakarai H, Tozawa K, Fukushima M, Kato S, Doi T, Taniguchi Y, Matsubayashi Y, Higashikawa A, Takeshita Y, Kawamura N, Inanami H, Tanaka S, Oshima Y. Comparison between microendoscopic laminectomy and open posterior decompression surgery for single-level lumbar spinal stenosis: a multicenter retrospective cohort study. BMC Musculoskelet Disord 2021; 22:1053. [PMID: 34930238 PMCID: PMC8690517 DOI: 10.1186/s12891-021-04963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Microendoscopic laminectomy (MEL), in which a 16-mm tubular retractor with an internal scope is used, has shown excellent surgical results for patients with lumbar spinal canal stenosis. However, no reports have directly compared MEL with open laminectomy. This study aimed to elucidate patient-reported outcomes (PROs) and perioperative complications in patients undergoing MEL versus open laminectomy. Methods This is a multicenter retrospective cohort study of prospectively registered patients who underwent lumbar spinal surgery at one of the six high-volume spine centers between April 2017 and September 2018. A total of 258 patients who underwent single posterior lumbar decompression at L4/L5 were enrolled in the study. With regard to demographic data, we prospectively used chart sheets to evaluate the diagnosis, operative procedure, operation time, estimated blood loss, and complications. The follow-up period was 1-year. PROs included a numerical rating scale (NRS) for lower back pain and leg pain, the Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), and patient satisfaction with the treatment. Results Of the 258 patients enrolled, 252 (97%) completed the 1-year follow-up. Of the 252, 130 underwent MEL (MEL group) and 122 underwent open decompression (open group). The MEL group required a significantly shorter operating time and sustained lesser intraoperative blood loss compared with the open group. The MEL group showed shorter length of postoperative hospitalization than the open group. The overall complication rate was similar (8.2% in the MEL group versus 7.7% in the open group), and the revision rate did not significantly differ. As for PROs, both preoperative and postoperative values did not significantly differ between the two groups. However, the satisfaction rate was higher in the MEL group (74%) than in the open group (53%) (p = 0.02). Conclusions MEL required a significantly shorter operating time and resulted in lesser intraoperative blood loss compared with laminectomy. Postoperative PROs and complication rates were not significantly different between the procedures, although MEL demonstrated a better satisfaction rate.
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Affiliation(s)
- Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Junya Miyahara
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yuichi Yoshida
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22Shibuya-Ku, HirooTokyo, 150-8935, Japan
| | - Hiroyuki Nakarai
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki City, Kanagawa, 211-8510, Japan
| | - Keiichiro Tozawa
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Yokohama Rosai Hospital, 3211 Kozukue-Cho, Kohoku-Ku, Yokohama City, Kanagawa, 222-0036, Japan
| | - Masayoshi Fukushima
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Spine Center, Toranomon Hospital, 2-2-2Minato-Ku, ToranomonTokyo, 105-8470, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki City, Kanagawa, 211-8510, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Orthopedic Surgery, Yokohama Rosai Hospital, 3211 Kozukue-Cho, Kohoku-Ku, Yokohama City, Kanagawa, 222-0036, Japan
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22Shibuya-Ku, HirooTokyo, 150-8935, Japan
| | - Hirohiko Inanami
- University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.,Inanami Spine and Joint Hospital, 3-17-5Shinagawa-Ku, HigashishinagawaTokyo, 140-0002, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan. .,University of Tokyo Spine Group (UTSG), 7-3-1Bunkyo-Ku, HongoTokyo, 113-8655, Japan.
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11
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Sulaiman A, Mahfoud M, Abdalrahman M. Comparison of sequestrectomy with or without nucleotomy in patients with sequestered fragment and small perforations within the fibrous ring: 2 years’ experience. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Garg K, Kasliwal MK. Outcomes and complications following minimally invasive excision of synovial cysts of the lumbar spine: A systematic review and meta-analysis. Clin Neurol Neurosurg 2021; 206:106667. [PMID: 33984755 DOI: 10.1016/j.clineuro.2021.106667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Lumbar synovial cysts (LSC) are one of the manifestations of spinal degenerative cascade. Spinal stenosis or presence of instability in these patients can lead to various symptoms and surgery is indicated following failure of non-operative management for symptomatic synovial cysts. Surgery when performed consists of either decompression with resection of cyst with our without fusion. The efficacy and complications of minimally invasive techniques using tubular retractors (microscopic or endoscopic) in comparison to traditional open techniques remain to be studied. METHODS A comprehensive search of different databases was performed to retrieve studies describing the use of minimal invasive techniques using tubular retractors (both microscopic and endoscopic) in patients with LSC. Meta-analysis with subgroup analysis and metaregression was done. RESULTS Twenty articles were selected for the systematic review and meta-analysis with total of 388 patients. Eighty-six percent of patients (95% Confidence Interval (CI): 80-90%) had favorable outcome as per Macnab's criteria (excellent and good outcome) with the pooled standard mean difference between preoperative and postoperative Oswestry Disability Index (ODI) being -4.44 (95% CI -8.78 to -0.10, p-value=0.0474, I2 82%). The pooled percentage change in visual analogue scale (VAS) after surgery was 76.5% (95% CI 66.9-84%, I2 82%). The pooled proportion of incidental durotomies, cyst recurrence and patients requiring operation being 8% (95% CI 5-11%, I2 0%), 4% (95% CI 2-7%, I2 0%,) and 5% (95% CI 3-9%) respectively. Studies were homogeneous with an I2 value of 0%. Subgroup analysis revealed no significant difference in the outcome rates or complication rates between the microscopic and endoscopic subgroups. CONCLUSION Minimally invasive techniques for the resection of LSC is a safe and effective alternative to traditional surgical approaches with no difference between the microscopic and endoscopic approaches.
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Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manish K Kasliwal
- University Hospitals Cleveland Medical Centre, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Alshameeri ZAF, Ahmed EN, Jasani V. Clinical Outcome of Spine Surgery Complicated by Accidental Dural Tears: Meta-Analysis of the Literature. Global Spine J 2021; 11:400-409. [PMID: 32875884 PMCID: PMC8013939 DOI: 10.1177/2192568220914876] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Systemic review and meta-analysis. OBJECTIVES Several studies have reported the impact of accidental dural tears (DT) on the outcome of spinal surgery, some with conflicting results. Therefore, the aim of this study was to carry out a systemic review and meta-analysis of the literature to establish the overall clinical outcome of spinal surgery following accidental DT. METHOD A systemic literature search was carried out. Postoperative improvement in Oswestry Disability Index (ODI), Short-Form 36 survey (SF36), leg pain visual analogue scale (VAS), and back pain VAS were compared between patients with and without DT at different time intervals. RESULTS Eleven studies were included in this meta-analysis. There was a slightly better improvement in ODI and leg VAS score (standardized mean difference of -0.06, 95% confidence interval [CI] -0.12 to -0.01, and -0.06, 95% CI -0.09 to -0.02, respectively) in patients without DT at 12 months postsurgery, but this effect was not demonstrated at any other time intervals up to 4 years. There were no differences in the overall SF36 (function) score at any time interval or back pain VAS at 12 months. CONCLUSION Based on this study, accidental DT did not have an overall significant adverse impact on the short-term clinical outcome of spinal surgery. More studies are needed to address the long-term impact and other outcome measures including other immediate complications of DT.
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Affiliation(s)
- Zeiad A. F. Alshameeri
- University Hospital of North Midlands, Stoke-on-Trent, UK,Zeiad A. F. Alshameeri, Department of Spinal Surgery, University Hospital of North Midlands, Newcastle Road, Stoke-on-Trent ST4 6QG, UK.
| | - El-Nasri Ahmed
- University Hospital of North Midlands, Stoke-on-Trent, UK
| | - Vinay Jasani
- University Hospital of North Midlands, Stoke-on-Trent, UK
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14
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Influence of unintended dural tears on postoperative outcomes in lumbar surgery patients: a multicenter observational study with propensity scoring. Spine J 2020; 20:1968-1975. [PMID: 32544720 DOI: 10.1016/j.spinee.2020.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Unintended dural tears (DTs) are common in spinal surgeries. Some authors have reported that the outcomes in lumbar surgery patients with DTs are equivalent to those in patients without DTs, but this remains uncertain. PURPOSE To assess the effect of unintended DTs on postoperative patient-reported outcomes. STUDY DESIGN/SETTING A multicenter retrospective observational study. PATIENT SAMPLE We enrolled patients undergoing lumbar spine surgery at eight hospitals between April 2017 and November 2018. OUTCOME MEASURES We collected data regarding patients' backgrounds, operative factors, occurrence of unplanned DTs during surgery, postoperative complications, patient-reported outcomes, such as pain or dysesthesia of the lower back, buttock, leg, or plantar area, EuroQol 5 Dimension (EQ-5D), Oswestry Disability Index (ODI) scores, and postoperative satisfaction. METHODS We divided the patients into a DT- group (without DTs) and a DT+ group (with DTs). First, multivariate logistic regression analyses were conducted to reveal risk factors for occurrence of DTs. Then, we used propensity score matching to obtain a matched DT- group (mDT- group) and a matched DT+ (mDT+ group). Student's t test was used for comparing continuous variables and Pearson's chi-square test for comparing categorical variables between the two groups. RESULTS We enrolled 2,146 patients in this study. The number of patients with unintended DTs was 166 (7.7%). Older age, body mass index, ossification of posterior longitudinal ligament / yellow ligament, spinal deformity, and revision surgery were significant risk factors for DTs. We used propensity score matching to compare 163 of the patients with DTs with 163 patients without DTs. No significant difference was found in postoperative pain or dysesthesia of the lower back, buttock, leg, and plantar area between the mDT- and mDT+ groups. When comparing preoperative with postoperative pain and dysesthesia, a statistically significant improvement was found in each group (p<.01 for all variables) except for sensory disorder of the plantar area, where a significant improvement was only observed in dysesthesia of the mDT- group (p<.01). Although some improvements were observed, they were not statistically significant in terms of pain in the mDT- (p=.06) and mDT+ (p=.13) groups and dysesthesia in the mDT+ (p=.13) group. No significant differences were found in postoperative outcomes, such as EQ-5D (p=.44) and ODI (p=.89) scores, and postoperative satisfaction (p=.73) between the two groups. CONCLUSIONS Although insufficient improvement of sensory disorder of the plantar area was observed, patients with DTs showed almost equivalent postoperative outcomes compared with patients without DTs.
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15
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Kim JE, Choi DJ, Park EJ. Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic Spine Surgery. Asian Spine J 2020; 14:790-800. [PMID: 32429015 PMCID: PMC7788375 DOI: 10.31616/asj.2019.0297] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/08/2019] [Indexed: 01/30/2023] Open
Abstract
Study Design Here we perform a retrospective analysis regarding an incidental dural tear (IDT) during biportal endoscopic spinal surgery (BESS). Purpose This study investigates the causes of IDT specifically related to technical procedures of BESS with the aim of lowering its risk during training. Overview of Literature The incidence of dural tear is reported 0.5%–18% in open spinal surgery and 1.7%–4.3% during endoscopic spinal surgery. Because conversion to open surgery for direct repair could become necessary during endoscopic spinal surgery, prevention of this complication is essential. Methods We have retrospectively studied IDTs by four surgeons during 1 or 2 years after starting BESS for lumbar degenerative diseases and analyzed the locations, sizes, and specific endoscopic conditions specific to each. Results Twenty-five cases (1.6%) of IDTs among 1,551 cases of BESS occurred; 13 cases (52%) of these were within the first 6 months. The locations were dorsal midline in 12 cases, ipsilateral side in 11 cases, and contralateral side in two cases. The tear sizes were <10 mm in 20 cases and ≥10 mm in five cases. IDT commonly occurred due to injury of central dural folding during flavectomy under turbid surgical fields due to small bleeds under water. Twenty cases with IDTs of <10 mm were treated well with the patch technique. Among five cases of ≥10 mm, three underwent open repair within a few days, and two of these which failed to conservative management required a delayed revision operation due to pseudomeningocele. No cases progressed to surgical site infection or infectious spondylitis. Conclusions IDTs of <10 mm can be successfully treated with the patch technique. To prevent IDT during the early learning period, maintaining clear visibility by securing fluent saline outflow and meticulous hemostasis of small bleeding from exposed cancellous bone and epidural vessels is essential with caution not to injure the central dural folding during midline flavectomy.
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Affiliation(s)
- Ju-Eun Kim
- Department of Orthopedic Surgery, Himnaera Hospital, Busan, Korea
| | - Dae-Jung Choi
- Department of Orthopedic Surgery, Himnaera Hospital, Busan, Korea
| | - Eugene J Park
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, Korea
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When is an incidental durotomy a complication during lumbar spine surgery? Spine J 2020; 20:685-687. [PMID: 32416875 DOI: 10.1016/j.spinee.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 02/03/2023]
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Alshameeri ZAF, El-Mubarak A, Kim E, Jasani V. A systematic review and meta-analysis on the management of accidental dural tears in spinal surgery: drowning in information but thirsty for a clear message. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1671-1685. [DOI: 10.1007/s00586-020-06401-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/21/2020] [Accepted: 03/28/2020] [Indexed: 12/29/2022]
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18
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Telfeian AE, Shen J, Ali R, Oyelese A, Fridley J, Gokaslan ZL. Incidence and Implications of Incidental Durotomy in Transforaminal Endoscopic Spine Surgery: Case Series. World Neurosurg 2019; 134:e951-e955. [PMID: 31734429 DOI: 10.1016/j.wneu.2019.11.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the incidence and outcomes of incidental durotomy in transforaminal endoscopic spine surgery. METHODS Transforaminal lumbar endoscopic procedures were performed by 2 surgeons in 907 patients over a period of 4 years from 2014 to 2018. Patient data were evaluated retrospectively in these patients with a minimum follow-up of 1 year. RESULTS In 907 patients over 4 years there were 5 durotomies: 4 incidental and 1 intentional. The rate for incidental durotomy was therefore 0.4%. There were no adverse outcomes from the incidental durotomies, and only 1 patient noted a headache. CONCLUSIONS Incidental durotomy is a rare complication of transforaminal lumbar endoscopic spine surgery and appears to occur more likely in patients who have undergone previous spine surgery at the site of the endoscopic procedure, not unexpectantly. Glues, patches, and bedrest were among the various methods used after durotomy. In this series there were no cases of symptomatic spinal fluid leakage or pseudomeningocele seen. Only 20% of patients who had durotomies noted a headache in the immediate postoperative period.
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Affiliation(s)
- Albert E Telfeian
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Jian Shen
- Mohawk Valley Orthopedics, Amsterdam, New York, USA
| | - Rohaid Ali
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adetokunbo Oyelese
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared Fridley
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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