Lakshmi Suryateja Gangavarapu, Hani Chanbour, Gabriel A Bendfeldt, Iyan Younus, Soren Jonzzon, Silky Chotai, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman
{"title":"Does an Unintended Durotomy in Metastatic Spine Surgery Lead to Shorter Survival?","authors":"Lakshmi Suryateja Gangavarapu, Hani Chanbour, Gabriel A Bendfeldt, Iyan Younus, Soren Jonzzon, Silky Chotai, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.1227/neuprac.0000000000000096","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Whether unintended durotomy in metastatic spine surgery seeds tumor in the central nervous system (CNS) remains unknown. Our objectives were to (1) determine the rate of unintended durotomy, (2) identify the preoperative and perioperative factors that increase the risk of unintended durotomy, and (3) determine whether unintended durotomy affected local recurrence (LR), any spinal recurrence, and overall survival.</p><p><strong>Methods: </strong>A single-center, retrospective cohort study of patients undergoing metastatic spine surgery between January 2010 to January 2021 was undertaken. The primary exposure variable was the occurrence of unintended durotomy. Multivariable logistic/linear regression were performed controlling for age, body mass index, tumor size, other organ metastases, and preoperative radiotherapy/chemotherapy.</p><p><strong>Results: </strong>Of 354 patients undergoing surgery for extradural spinal metastasis, 19 patients (5.4%) had an unintended durotomy. Preoperatively: No difference was found between patients with and without unintended durotomy regarding basic demographics, comorbidities (<i>P</i> = .645), or tumor histology (<i>P</i> = .642). Preoperative chemotherapy/radiotherapy were similar between the 2 groups. Perioperatively: Although patients with unintended durotomy had more costotransversectomies (36.8% vs 12.8%, <i>P</i> = .010), no difference was found in tumor characteristics, operative time (337.4 vs 310.6 minutes, <i>P</i> = .150), blood loss (1012.8 vs 883.8 mL, <i>P</i> = .157), length of stay (6.4 vs 6.9 days, <i>P</i> = .452), or overall reoperation/readmission. Long-term: No difference was seen in CNS spread between those with unintended durotomy and no durotomy (10.5% vs 3.0%, <i>P</i> = .077). LR (5.3% vs 12.2%, <i>P</i> = .712), time to LR (388.0 vs 213.3 ± 359.8 days, log-rank; <i>P</i> = .709), any spinal recurrence (26.3% vs 34.0%, <i>P</i> = .489), overall survival (21.05% vs 34.3%, <i>P</i> = .233), and time to death (466.9 ± 634.7 vs 465.8 ± 665.4 days, log-rank; <i>P</i> = .394) were similar on multivariable Cox regressions.</p><p><strong>Conclusion: </strong>In patients undergoing surgery for extradural spinal metastases, 5% had an unintended durotomy, and costotransversectomies were associated with increased risk of an unintended durotomy. Unintended durotomies did not lead to increased LR or shorter survival. Taken together, shortened survival due to seeding tumor into the CNS after an unintended durotomy was not observed.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00096"},"PeriodicalIF":0.0000,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783639/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgery practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1227/neuprac.0000000000000096","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objectives: Whether unintended durotomy in metastatic spine surgery seeds tumor in the central nervous system (CNS) remains unknown. Our objectives were to (1) determine the rate of unintended durotomy, (2) identify the preoperative and perioperative factors that increase the risk of unintended durotomy, and (3) determine whether unintended durotomy affected local recurrence (LR), any spinal recurrence, and overall survival.
Methods: A single-center, retrospective cohort study of patients undergoing metastatic spine surgery between January 2010 to January 2021 was undertaken. The primary exposure variable was the occurrence of unintended durotomy. Multivariable logistic/linear regression were performed controlling for age, body mass index, tumor size, other organ metastases, and preoperative radiotherapy/chemotherapy.
Results: Of 354 patients undergoing surgery for extradural spinal metastasis, 19 patients (5.4%) had an unintended durotomy. Preoperatively: No difference was found between patients with and without unintended durotomy regarding basic demographics, comorbidities (P = .645), or tumor histology (P = .642). Preoperative chemotherapy/radiotherapy were similar between the 2 groups. Perioperatively: Although patients with unintended durotomy had more costotransversectomies (36.8% vs 12.8%, P = .010), no difference was found in tumor characteristics, operative time (337.4 vs 310.6 minutes, P = .150), blood loss (1012.8 vs 883.8 mL, P = .157), length of stay (6.4 vs 6.9 days, P = .452), or overall reoperation/readmission. Long-term: No difference was seen in CNS spread between those with unintended durotomy and no durotomy (10.5% vs 3.0%, P = .077). LR (5.3% vs 12.2%, P = .712), time to LR (388.0 vs 213.3 ± 359.8 days, log-rank; P = .709), any spinal recurrence (26.3% vs 34.0%, P = .489), overall survival (21.05% vs 34.3%, P = .233), and time to death (466.9 ± 634.7 vs 465.8 ± 665.4 days, log-rank; P = .394) were similar on multivariable Cox regressions.
Conclusion: In patients undergoing surgery for extradural spinal metastases, 5% had an unintended durotomy, and costotransversectomies were associated with increased risk of an unintended durotomy. Unintended durotomies did not lead to increased LR or shorter survival. Taken together, shortened survival due to seeding tumor into the CNS after an unintended durotomy was not observed.
背景和目的:转移性脊柱手术中意外硬膜切开是否会导致中枢神经系统(CNS)肿瘤仍不清楚。我们的目的是:(1)确定意外硬膜切开的发生率,(2)确定术前和围手术期增加意外硬膜切开风险的因素,以及(3)确定意外硬膜切开是否影响局部复发(LR)、任何脊柱复发和总生存率。方法:对2010年1月至2021年1月接受转移性脊柱手术的患者进行单中心、回顾性队列研究。主要暴露变量是意外硬膜切开的发生。采用多变量logistic/线性回归控制年龄、体重指数、肿瘤大小、其他器官转移和术前放疗/化疗。结果:354例硬膜外脊柱转移手术患者中,19例(5.4%)发生意外硬膜切开。术前:在基本人口统计学、合并症(P = .645)或肿瘤组织学(P = .642)方面,进行和未进行意外硬膜切开术的患者没有差异。两组患者术前化疗/放疗效果相似。围手术期:尽管非预期硬膜切除术患者有更多的成本横切(36.8% vs 12.8%, P = 0.010),但在肿瘤特征、手术时间(337.4 vs 310.6分钟,P = 0.150)、出血量(1012.8 vs 883.8 mL, P = 0.157)、住院时间(6.4 vs 6.9天,P = 0.452)或总体再手术/再入院方面没有发现差异。长期:未切开硬膜组和未切开硬膜组的中枢神经系统扩散无差异(10.5% vs 3.0%, P = 0.077)。LR (5.3% vs 12.2%, P = .712),到达LR的时间(388.0 vs 213.3±359.8天,log-rank;P = .709)、脊柱复发(26.3% vs . 34.0%, P = .489)、总生存率(21.05% vs . 34.3%, P = .233)和死亡时间(466.9±634.7 vs 465.8±665.4天,log-rank;P = .394),多变量Cox回归结果相似。结论:在接受硬膜外脊髓转移手术的患者中,5%的患者发生了意外的硬膜切除术,而肋横切术与意外硬膜切除术的风险增加有关。意外硬膜切开术并未导致LR增加或生存期缩短。综上所述,未观察到意外硬膜切开后肿瘤植入中枢神经系统而缩短的生存期。