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Journal of Neurosurgical Sciences 2019 Oct 08

DOI: 10.23736/S0390-5616.19.04807-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Invasiveness has no influence on the rate of incidental durotomies in surgery for multisegmental lumbar spinal canal stenosis (≥ 3 levels) with and without fusion. Analysis from the German Spine Registry data (DWG-Register)

Juan Manuel VINAS-RIOS 1 , Michael RAUSCHMANN 1, Richard SELLEI 2, Jose J. SANCHEZ-RODRIGUEZ 3, Frerk MEYER 4, Mohammad ARABMOTLAGH 1, DWG-Registry study group

1 Department of Spine Surgery, Sanaklinik, Offenbach am Main, Germany; 2 Department of Traumatology, Sanaklinik, Offenbach am Main, Germany; 3 Department of Neurosurgery Klinikum Braunschweig, Braunschweig, Germany; 4 Department of Spine Surgery, University Clinic for Neurosurgery, Evangelisches Krankenhaus, Oldenburg, Germany


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BACKGROUND: Nowadays, perioperative complications as dural tear (DT) with subsequent neurological deficits are documented in independent registers. However, the relationship of these complications with the grade of invasiveness (≥3 levels) is still unclear. We attempted to evaluate perioperative complications, particularly DT with subsequent neurological deficits, between patients undergoing laminotomy and decompression and decompression and fusion in ≥3 levels.
METHODS: Retrospective analysis of the data pool of the DWG register based on cases described by 10 clinics between January 2012 and December 2016 was performed. Surgically treated LSS in ≥3 segments were divided into decompression with or without instrumentation and fusion. Cases with intraoperative DT in both subgroups were analysed for risk factor occurrence. The Surgical Invasive Index (SII) was used.
RESULTS: DT occurred in 102/941 (10.8%) patients. Difference in DT between groups was non- significant. The likelihood of DT increased by 2.12-fold with previous spinal surgery at the same level and by 1.9-fold for BMI 30-34 and >35 in comparison with BMI 26-29, respectively. Postoperative deep wound infection was increased by 2.39-fold after DT than without. Significance in outcomes between patients with/without DT was not found. The invasiveness index explained 48% of the variation in blood loss and 51% of the variation in surgery duration.
CONCLUSIONS: The rate of incidental DT during decompression for LSS with and without fusion in ≥3 levels was associated with BMI and previous surgery at the same spinal level. Invasivness (SII) is valid rather for variables proper to surgery such as bledding and Op-time but no with incidence for DT and subsequent CSF-leackage.


KEY WORDS: Spinal canal stenosis; Spine surgery; German Spine Registry; Complications; Dural tear

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