Menu
Menu
19 Harley St, London, W1G 9QJ, UK

Late-presenting dural tear: incidence, threat elements, and related issues.

Related Articles

Late-presenting dural tear: incidence, threat elements, and related issues.

Backbone J. 2018 Apr 18;:

Authors: Durand WM, DePasse JM, Kuris EO, Yang J, Daniels AH

Summary
BACKGROUND CONTEXT: Unrecognized and inadequately repaired intraoperative durotomies might result in cerebrospinal fluid leak, pseudomeningocele, and different issues. Few research have investigated durotomy that’s unrecognized intraoperatively and requires extra postoperative administration (hereafter, late-presenting dural tear [LPDT]), although estimates of LPDT vary from zero.6 – eight.three per 1,000 spinal surgical procedures. These single-center research are primarily based on comparatively small pattern sizes for an occasion of this rarity, all with <10 sufferers experiencing LPDT.
PURPOSE: This investigation is the biggest but performed on LPDT, and sought to establish incidence, threat elements for, and issues related to LPDT.
STUDY DESIGN/SETTING: This observational cohort research employed the ACS NSQIP dataset (years 2012 – 2015).
PATIENT SAMPLE: Sufferers present process backbone surgical procedure have been recognized primarily based on presence of main listed CPT codes comparable to spinal fusion or remoted posterior decompression with out fusion.
OUTCOME MEASURES: The first variable on this research was prevalence of late-presenting dural tear, recognized as reoperation or readmission with durotomy-specific CPT or ICD-9-CM codes however with out durotomy codes current for the index process.
METHODS: Descriptive statistics have been generated. Bivariate and multivariate analyses have been performed utilizing Chi-Sq. checks and a number of logistic regression, respectively, producing each threat elements for LPDT and impartial affiliation of LPDT with postoperative issues. Statistical significance was outlined as p<zero.05. No funding was obtained in assist of this research. The authors report no related conflicts of curiosity.
RESULTS: In complete, 86,212 sufferers have been analyzed. The general price of reoperation or readmission with out reoperation for LPDT was 2.zero per 1,000 sufferers (n=174). 97.7% of LPDT sufferers required a number of unplanned reoperations (n=170), and 5.7% of sufferers (n=10) required two reoperations. On multivariate evaluation, lumbar procedures (odds ratio [OR] 2.79, p<zero.0001, vs. cervical), procedures involving each cervical and lumbar ranges (OR three.78, p=zero.0338, vs. cervical solely), procedures with decompression solely (OR 1.72, p=zero.0017, vs. fusion and decompression), and operative period ?250 minutes (OR 1.70, p=zero.0058, vs. <250 minutes) have been related to elevated probability of LPDT. LPDT was considerably related to surgical website an infection (SSI) (OR 2.54, p<zero.0001), wound disruption (OR 2.24, p<zero.0001), sepsis (OR 2.19, p<zero.0001), thromboembolism (OR 1.71, p<zero.0001), acute kidney damage (OR 1.59, p=zero.0281), pneumonia (OR 1.14, p=zero.0269), and urinary tract an infection (UTI) (OR 1.08, p=zero.0057).
CONCLUSIONS: Late-presenting dural tears occurred in 2.zero per 1,000 backbone surgical procedure sufferers. Sufferers present process lumbar procedures, decompression procedures, and procedures with operative period ?250 minutes have been at elevated threat for LPDT. Additional, LPDT was independently related to elevated probability of SSI, sepsis, pneumonia, UTI, wound dehiscence, thromboembolism, and acute kidney damage. As LPDT is related to markedly elevated morbidity and potential legal responsibility threat, backbone surgeons ought to concentrate on best-practice administration for LPDT and take into account it as a uncommon, however potential etiology for growing postoperative issues.

PMID: 29679726 [PubMed – as supplied by publisher]

Related Articles Late-presenting dural tear: incidence, risk factors, and associated complications. Spine J. 2018 Apr 18;: Authors: Durand WM, DePasse JM, Kuris EO, Yang J, Daniels AH Abstract BACKG...

What our patients say ...

Consultant Spinal Surgeon
Consultant Spinal Surgeon
Consultant Spinal Surgeon
Consultant Spinal Surgeon
Consultant Spinal Surgeon
Consultant Spinal Anaesthetist

This surgical technique consists of a percutaneous approach for the treatment of small to medium size hernias of the intervertebral disc by laser energy. The main objective is to reduce the intradiscal pressure in the nucleus pulposus

Laser Disc Surgery can be performed under local anaesthetic as a day case at our centre on the prestigious Harley Street.
What is London spine unit and How it Works

The London Spine Unit was established in 2005 and has successfully treated over 5000 patients. All conditions are treated.

treatment of all spinal disorders

The London Spine Unit specialises in Minimally Invasive Treatments allowing rapid recovery and return to normal function

Trusted by patients worldwide

The London Spine Unit provides the highest quality care to all patients and has VIP services for those seeking exceptional services

Laser Spine Surgery Articles

SHADES of grey – The challenge of ‘grumbling’ cauda equina symptoms in older adults with lumbar spinal stenosis.
Abstract Diagnosing cauda equina syndrome is challenging in older adults with lumbar spinal stenosis. Understanding these challenges is vital for
Read more.
The influence of preoperative mental health on clinical outcomes after laminectomy in patients with lumbar spinal stenosis.
Abstract OBJECTIVE: The influence of preoperative mental health on health-related quality of life (HRQOL) in patients with lumbar spinal stenosis
Read more.
MicroRNA transcriptome analysis on hypertrophy of ligamentum flavum in patients with lumbar spinal stenosis.
Abstract Introduction: Molecular pathways involved in ligamentum flavum (LF) hypertrophy are still unclarified. The purpose of this study was to
Read more.
Salvage Strategy for Failed Spinal Fusion Surgery Using Lumbar Lateral Interbody Fusion technique: A Technical Note.
Abstract Introduction: Failed spinal fusion surgery sometimes requires salvage surgery when symptomatic, especially with postsurgical decrease in intervertebral disc height
Read more.
Integrated anatomy of the neuromuscular, visceral, vascular, and urinary tissues determined by MRI for a surgical approach to lateral lumbar
Abstract Introduction: To comprehensively investigate the anatomy of the neuromuscular, visceral, vascular, and urinary tissues and their general influence on
Read more.
Clinical Outcomes of Treating Cervical Adjacent Segment Disease by Anterior Cervical Discectomy and Fusion Versus Total Disc Replacement: A Systematic
Related Articles Clinical Outcomes of Treating Cervical Adjacent Segment Disease by Anterior Cervical Discectomy and Fusion Versus Total Disc Replacement:
Read more.

If you have any emergency Doctor’s need, simply call our 24 hour emergency

Your personal case manager will ensure that you receive the best possible care.

Call Now 

+44 844 589 2020
+44 203 973 8810