Dural Tears in Grownup Deformity Surgical procedure: Incidence, Threat Components, and Outcomes.
World Backbone J. 2018 Feb;eight(1):25-31
Authors: Iyer S, Klineberg EO, Zebala LP, Kelly MP, Hart RA, Gupta MC, Hamilton DK, Mundis GM, Sciubba D, Ames CP, Smith JS, Lafage V, Burton D, Kim HJ, Worldwide Backbone Research Group (ISSG)
Research Design: Retrospective cohort examine.
Targets: Describe the speed of dural tears (DTs) in grownup spinal deformity (ASD) surgical procedure. Describe the chance elements for DT and the affect of this complication on medical outcomes.
Strategies: Sufferers with ASD present process surgical procedure between 2008 and 2014 have been separated into DT and non-DT cohorts; demographics, operative particulars, radiographic, and medical outcomes have been in contrast. Statistical evaluation included t exams or ?2 exams as acceptable and a multivariate evaluation.
Outcomes: A complete of 564 sufferers have been recognized. The speed of DT was 10.eight% (n = 61). Sufferers with DT have been older (61.1 vs 56.5 years, P = .005) and have been extra prone to have had prior backbone surgical procedure (odds ratio [OR] = 2.zero, 95% confidence interval [CI] = 1.2-Three.Three, P = .007). DT sufferers had larger pelvic tilt, decrease lumbar lordosis, and better pelvic-incidence lumbar lordosis mismatch than non-DT sufferers (P < .05). DT sufferers had longer operative occasions (424 vs 375 minutes, P = .008), have been extra prone to endure interbody fusions (OR = 2.zero, 95% CI = 1.1-Three.6, P = .021), osteotomies (OR = 2.2, 95% CI = 1.1-Four.zero, P = .012), and decompressions (OR = 2.Three, 95% CI = 1.Three-Four.Three, P = .003). In our multivariate evaluation, solely decompressions have been related to an elevated threat of DT (OR = Three.2, 95% CI = 1.Four-7.6, P = .006). There have been no important variations in affected person outcomes at 2 years.
Conclusions: The speed of DT was 10.eight% in an ASD cohort. That is just like charges of DT reported following surgical procedure for degenerative pathology. A historical past of prior backbone surgical procedure, decompression, interbody fusion, and osteotomies are all related to an elevated threat of DT, however decompression is the one impartial threat issue for DT.
PMID: 29456912 [PubMed]