Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic Spine Surgery

Kim, Jueun; Choi, Dae-Jung; Park, Eugene J.

doi:10.31616/asj.2019.0297

Cited by 40 publications

(28 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…regarding durotomy, rate varies in the literature between 0.5 and 18% [23]. In our study, the occurrence of a durotomy represented strong risk factor for severe complications.…”

Section: Management Of Comorbiditiesmentioning

confidence: 49%

Surgical Management of Lumbar Spinal Stenosis in Patients Over 80 : Is There an Increased Risk ?

Rault

Briant²,

Gaberel

et al. 2021

Preprint

View full text Add to dashboard Cite

Introduction:Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complications rate was higher for elderly patients and to find confounding factors.Material and MethodsWe conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded.Results996 patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. 5.2% of patients presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI, and accidental durotomies were independent risk factors for SC.ConclusionSurgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complications risk is increased although an optimal preparation is the way to avoid them.

show abstract

“…regarding durotomy, rate varies in the literature between 0.5 and 18% [23]. In our study, the occurrence of a durotomy represented strong risk factor for severe complications.…”

Section: Management Of Comorbiditiesmentioning

confidence: 49%

Surgical Management of Lumbar Spinal Stenosis in Patients Over 80 : Is There an Increased Risk ?

Rault

Briant²,

Gaberel

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Secondly, regarding durotomy, its rate varies in the literature between 0.5 and 18% [23]. In our study, the occurrence of a durotomy represented a strong risk factor for severe complications.…”

Section: Management Of Comorbiditiesmentioning

confidence: 54%

Surgical management of lumbar spinal stenosis in patients over 80: is there an increased risk?

Rault

Briant²,

Kamga

et al. 2022

Neurosurg Rev

View full text Add to dashboard Cite

Management of lumbar spinal stenosis (LSS) represents the rst cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complications rate was higher for elderly patients and to nd confounding factors. Material and MethodsWe conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded. Results996 patients undergoing surgery for degenerative LSS were identi ed. Patients over 80 were signi cantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. 5.2% of patients presented SC. Age over 80 did not appear to be a signi cant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI, and accidental durotomies were independent risk factors for SC. ConclusionSurgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age.However, preoperative risk factors should be investigated to warn the elderly patients that the complications risk is increased although an optimal preparation is the way to avoid them.

show abstract

“…13,16 The most frequently encountered complication in UBE decompression was dural tear, with an incidence that varied from 1.5% to 9.7%. [34][35][36][37] While most of the dural tears were very small and could be managed conservatively, a dural tear larger than 10 mm would need to be repaired to prevent cerebrospinal fluid leakage and its sequels. 35 Direct dural repair under endoscope is possible but technically demanding.…”

Section: Discussionmentioning

confidence: 99%

“…[34][35][36][37] While most of the dural tears were very small and could be managed conservatively, a dural tear larger than 10 mm would need to be repaired to prevent cerebrospinal fluid leakage and its sequels. 35 Direct dural repair under endoscope is possible but technically demanding. Therefore, a variety of alternative methods have been proposed to help effectively seal the dural tears.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a variety of alternative methods have been proposed to help effectively seal the dural tears. [35][36][37] Like the UE technique, the UBE technique depends on continuous normal saline irrigation during the surgical procedure. The hydrostatic pressure may propagate upward through the dural tear and damage the central nervous system.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Review of Unilateral Biportal Endoscopic Decompression for Degenerative Lumbar Canal Stenosis

Pao

2021

Int J Spine Surg

View full text Add to dashboard Cite

Background: The unilateral biportal endoscopic (UBE) technique provides minimally invasive decompression for degenerative lumbar canal stenosis (DLCS). With appropriate control of the hydrostatic pressure of normal saline irrigation, the surgery can be performed in a clear and magnified surgical field through 2 small surgical wounds.Methods: A review of published literature in PubMed was performed to identify studies of UBE decompression for DLCS. The outcome measures include operation time, length of hospital stay, estimated blood loss, visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), and the Macnab criteria.Results: A total of 76 relevant studies were retrieved through the PubMed search. After screening, 15 studies comprising 6 case series, 6 comparative studies, and 3 randomized controlled trials were included in this review. Significant improvements in pain and neurological symptoms were obtained in all studies. In the 6 case series studies, the outcome measures were extracted from each study and summarized. The follow-up periods ranged from 8.6 to 29 months. The operation time was 72.0 min. The VAS score for leg pain was reduced from 7.8 to 1.7, and the VAS score for back pain was reduced from 5.8 to 1.7. The ODI was reduced from 63.0 to 20.7, and 87.3% of patients reported good to excellent outcomes according to the Macnab criteria. The complication rates ranged from 5.5% to 13.8%, with dural tear having the highest incidence rate. In the comparative studies and randomized controlled trials examining the UBE, microscopic, microendoscopic, and uniportal endoscopic techniques, the UBE technique showed treatment results that were comparable with the others. Compared with the microscopic technique, the UBE technique resulted in significantly less tissue trauma and quicker recovery with less wound pain, lower serum creatine kinase and C-reactive protein levels, and lower ODI in the very early postoperative period. The UBE technique also provided adequate decompression with less facet joint destruction than all the other decompression techniques.Conclusions: The UBE technique is safe and effective for decompression of DLCS. Along with its efficacy in decompression, this technique is capable of preserving segmental stability. However, a long-term comparative study is required to verify this hypothesis.

show abstract

Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic Spine Surgery

Cited by 40 publications

References 27 publications

Surgical Management of Lumbar Spinal Stenosis in Patients Over 80 : Is There an Increased Risk ?

Surgical Management of Lumbar Spinal Stenosis in Patients Over 80 : Is There an Increased Risk ?

Surgical management of lumbar spinal stenosis in patients over 80: is there an increased risk?

A Review of Unilateral Biportal Endoscopic Decompression for Degenerative Lumbar Canal Stenosis

Contact Info

Product

Resources

About