Incidental dural tears during pediatric posterior spinal fusions.

IF 1.6 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI:10.1007/s43390-024-00873-4

Paal K Nilssen, Edward Compton, Stephen Stephan, Lindsay M Andras, Jason K Chu, David L Skaggs, Kenneth D Illingworth

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引用次数: 0

Abstract

Purpose: To characterize the frequency of incidental dural tears in pediatric spine surgery, their treatment, complications, and results of long-term follow-up.

Methods: A retrospective review of all pediatric patients who underwent a posterior spinal fusion (PSF) between 2004-2019 at a tertiary children's hospital was conducted. Electronic medical records were reviewed for patient demographics, intra-operative data, presence of an incidental dural tear, repair method, and patient outcomes.

Results: 3043 PSFs were reviewed, with 99 dural tears identified in 94 patients (3.3% overall incidence). Mean follow-up was 35.7 months (range 0.1-142.5). When the cause of the dural tear was specified, 69% occurred during exposure, 5% during pedicle screw placement, 4% during osteotomy, 2% during removal of implants, and 2% during intra-thecal injection of morphine. The rate of dural tears during primary PSF was significantly lower than during revision PSF procedures (2.6% vs. 6.2%, p < 0.05). 86.9% of dural tears were repaired and/or sealed intraoperatively, while 13.1% had spontaneous resolution. Postoperative headaches developed in 13.1% of patients and resolved at a mean of 7.6 days. There was no difference in the incidence of headaches in patients that were ordered bedrest vs. no bedrest (p > 0.99). Postoperative infections occurred in 9.5% of patients and 24.1% patients were identified to have undergone a revision surgery.

Conclusions: Incidence of intra-operative dural tears in pediatric spine surgery is 3.3%. Although complications associated with the dural tear occur, most resolve over time and there were no long-term sequelae in patients with 2 years of follow up.

Level of evidence: Level IV.

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小儿脊柱后路融合术中偶然出现的硬脑膜撕裂。

目的：了解小儿脊柱手术中意外硬膜撕裂的发生频率、治疗方法、并发症及长期随访结果：方法：对一家三级儿童医院 2004-2019 年间接受脊柱后路融合术（PSF）的所有儿科患者进行回顾性研究。研究人员查阅了电子病历，以了解患者的人口统计学特征、术中数据、是否存在意外硬脊膜撕裂、修复方法和患者预后：共审查了 3043 例 PSF，在 94 名患者中发现了 99 例硬膜撕裂（总发生率为 3.3%）。平均随访时间为 35.7 个月（0.1-142.5 个月）。当硬膜撕裂的原因明确时，69%发生在暴露过程中，5%发生在椎弓根螺钉置入过程中，4%发生在截骨过程中，2%发生在移除植入物过程中，2%发生在椎管内注射吗啡过程中。初次 PSF 手术的硬膜撕裂率明显低于翻修 PSF 手术（2.6% 对 6.2%，P 0.99）。9.5%的患者发生了术后感染，24.1%的患者被确认接受了翻修手术：结论：小儿脊柱手术中术中硬膜撕裂的发生率为3.3%。结论：小儿脊柱手术中术中硬脊膜撕裂的发生率为3.3%，虽然会出现硬脊膜撕裂相关并发症，但大多数并发症会随着时间的推移而消失，在2年的随访中，患者没有出现长期后遗症：证据等级：IV 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.