Prognosis of Incidental Dural Tear in Patients Who Underwent Lumbar Discectomy With Microsurgery; A Single Center Retrospective Analysis

Öz

Background: Dural tear is the most common complication during lumbar discectomy. It may lead to additional complications. In our study, we examined the incidence of dural tears in patients undergo-ing lumbar microsurgery, the risk factors, the methods we used in cases with intraoperative dural tears, and the postoperative complications. Materials and Methods: In our study, 1845 patients who underwent lumbar microdiscectomy at our hospital were examined. The level and side of the surgery, as well as whether revision discectomy was performed and whether a dural tear occurred, were recorded. Intraoperative and postoperative pro-cesses were investigated and subjected to statistical analysis. Results: In 171 out of 1845 patients, a dural tear occurred. The average age of patients with dural tears was found to be 53, which was significantly higher compared to patients without dural tears. (p<0,001) The rate of dural tears was significantly higher in patients who underwent bilateral dis-cectomy. (p<0,001) When examining the operation levels, the rate of dural tears was significantly higher in surgeries performed at the L4-5 level, multiple levels, and in revision discectomies. (p<0,001) Among the 171 patients who experienced a dural tear, 19 required rehospitalization or reoperation for various reasons. Conclusions: Dural tears are a frightening complication for neurosurgeons due to their potential out-comes. Our results identified increasing age, surgeries performed at the L4-5 level, bilateral and mul-tiple level surgeries, and revision surgeries as risk factors for dural tears. Regarding the need for reo-peration or rehospitalization following a dural tear, we found no significant differences between the application of intraoperative primary suturing, tissue grafts, or tissue adhesives.

Lomber Mikrocerrahi ile Diskektomi Yapılan Hastalarda Tesadüfi Dural Yırtık Prognozunun İncelenmesi; Tek Merkezli Retrospektif Analiz

Öz

Amaç: Dural yırtık, lomber diskektomi sırasında en sık görülen komplikasyondur. Ek komplikasyonlara yol açabilmektedir. Çalışmamızda lomber mikrocerrahi yaptığımız hastalarda dural yırtık görülme oranını, risk faktörlerini, intraoperatif dural yırtık gelişenlerde uyguladığımız yöntemleri ve postoperat-if komplikasyonları inceledik. Materyal ve metod: Çalışmamızda hastanemizde lomber mikrocerrahi diskektomi yapılan 1845 hasta incelendi. Hastaların hangi seviyeden ve hangi taraftan opere edildikleri ve nüks diskektomi yapılıp yapılmadığı, dural yırtık gelişip gelişmediği kayıt altına alınmıştır. İntraoperatif ve postoperatif süreçler sorgulanarak istatistiki analize tabi tutulmuştur. Bulgular: 1845 hastanın 171’inde dural yırtık gelişmiştir. Dural yırtık gelişen hastalarda yaş ortalaması 53 olarak tespit edilmiş, dural yırtık gelişmeyen hastalara göre anlamlı olarak yüksek bulunmuştur. (p<0,001) Bilateral diskektomi yapılan hastalarda dural yırtık gelişme oranı anlamlı olarak yüksek bu-lunmuştur. (p<0,001) Hastaların operasyon seviyeleri incelendiğinde L4-5 mesafesinden ve birden çok seviyeden yapılan operasyonlar ile nüks diskektomilerde dural yırtık gelişme oranı anlamlı olarak yük-sek bulunmuştır. (p<0,001) Dural yırtık gelişen 171 hastanın 19’unda çeşitli sebepler ile tekrar yatış ya da reoperasyon ihtiyacı olmuştur. Sonuç: Dural yırtık sonuçları itibariyle nöroşirurjiyenler için korkutucu bir komplikasyondur. Elde etti-ğimiz sonuçlar dural yırtığın risk faktörleri olarak, artan yaş, L4-5 seviyesinden yapılan operasyonlar, bilateral ve çok seviye operasyonlar ile nüks operasyonları tespit etmiştir. Dural yırtık sonrası reope-rasyon veya yeniden yatış gereksinimi üzerine, intraoperatif primer sütürasyon, doku grefti veya doku yapıştırıcısı uygulamanın anlamlı farklılıklar oluşturmadığını tespit ettik.

Anahtar Kelimeler

• Dural yırtık
• Spinal cerrahi
• Beyin omurilik sıvısı(BOS) kaçağı

Kaynakça

1. 1. Espiritu MT, Rhyne A, Darden BV, 2nd. Dural tears in spine surgery. J Am Acad Orthop Surg. 2010;18(9):537-45.
2. 2. Eismont FJ, Wiesel SW, Rothman RH. Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am. 1981;63(7):1132-6.
3. 3. Alshameeri ZAF, Jasani V. Risk Factors for Accidental Dural Tears in Spinal Surgery. Int J Spine Surg. 2021;15(3):536-48.
4. 4. Alluri R, Kang HP, Bouz G, Wang J, Hah RJ. The True Effect of a Lumbar Dural Tear on Complications and Cost. Spine (Phila Pa 1976). 2020;45(3):E155-e62.
5. 5. Khan MH, Rihn J, Steele G, Davis R, Donaldson WF, 3rd, Kang JD, et al. Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a re-view of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976). 2006;31(22):2609-13.
6. 6. Cammisa FPJ, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental Durotomy in Spine Surgery. Spine. 2000;25(20):2663-7.
7. 7. Epstein NE. The frequency and etiology of intraoperative dural tears in 110 predominantly geriatric patients undergo-ing multilevel laminectomy with noninstrumented fusions. J Spinal Disord Tech. 2007;20(5):380-6.
8. 8. Yoshihara H, Yoneoka D. Incidental dural tear in spine surgery: analysis of a nationwide database. Eur Spine J. 2014;23(2):389-94.

9. 9. Takahashi Y, Sato T, Hyodo H, Kawamata T, Takahashi E, Miyatake N, et al. Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations: clinical article. J Neurosurg Spine. 2013;18(2):165-9.
10. 10. Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017;10(4):507-16.
11. 11. Bosacco SJ, Gardner MJ, Guille JT. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res. 2001(389):238-47.
12. 12. Baker GA, Cizik AM, Bransford RJ, Bellabarba C, Konodi MA, Chapman JR, et al. Risk factors for unintended durotomy dur-ing spine surgery: a multivariate analysis. Spine J. 2012;12(2):121-6.
13. 13. Taylor C, Khan A, Shenouda E, Brooke N, Nader-Sepahi A. Dural tear repair surgery comparative analysis: a stitch in time saves nine. Eur Spine J. 2022;31(3):575-95.
14. 14. Albayrak S, Ozturk S, Ayden O, Ucler N. Dural Tear: A Feared Complication of Lumbar Discectomy. Turk Neurosurg. 2016;26(6):918-21.
15. 15. Smorgick Y, Baker KC, Herkowitz H, Montgomery D, Badve SA, Bachison C, et al. Predisposing factors for dural tear in pa-tients undergoing lumbar spine surgery. J Neurosurg Spine. 2015;22(5):483-6.
16. 16. Guerin P, El Fegoun AB, Obeid I, Gille O, Lelong L, Luc S, et al. Incidental durotomy during spine surgery: incidence, man-agement and complications. A retrospective review. Injury. 2012;43(4):397-401.
17. 17. Wang JC, Bohlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. Management and results af-ter a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am. 1998;80(12):1728-32.
18. 18. Choi EH, Chan AY, Brown NJ, Lien BV, Sahyouni R, Chan AK, et al. Effectiveness of Repair Techniques for Spinal Dural Tears: A Systematic Review. World Neurosurg. 2021;149:140-7.
19. 19. 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. Eur Spine J. 2020;29(7):1671-85.