163. Dural Lesions in Lumbar Disc Herniation Surgery – Incidence, Risk Factors and Effect on Outcome

2009 ◽  
Vol 9 (10) ◽  
pp. 85S
Author(s):  
Björn Strömqvist ◽  
Fredrik Strömqvist ◽  
Bo Jönsson
2009 ◽  
Vol 19 (3) ◽  
pp. 439-442 ◽  
Author(s):  
Fredrik Strömqvist ◽  
◽  
Bo Jönsson ◽  
Björn Strömqvist

2015 ◽  
Vol 22 (1) ◽  
pp. 20-26 ◽  
Author(s):  
D. Adam ◽  
T. Papacocea ◽  
R. Iliescu ◽  
I. Hornea ◽  
C. Moisescu

Abstract Incidental durotomy is a common complication of lumbar spine operations for degenerative disorders. Its incidence varies depending on several risk factors and regarding the intra and postoperative management, there is no consensus. Our objective was to report our experience with incidental durotomy in patients who were operated on for lumbar disc herniation, lumbar spinal stenosis and revision surgeries. Between 2009 and 2012, 1259 patients were operated on for degenerative lumbar disorders. For primary operations, the surgical approach was mino-open, interlamar, uni- or bilateral, as for recurrences, the removal of the compressive element was intended: the epidural scar and the disc fragment. 863 patients (67,7%) were operated on for lumbar disc herniation, 344 patients (27,3%) were operated on for lumbar spinal stenosis and 52 patients (5%) were operated for recurrences. The operations were performed by neurosurgeons with the same professional degree but with different operative volume. Unintentional durotomy occurred in 20 (2,3%) of the patients with herniated disc, in 14 (4,07%) of the patients with lumbar spinal stenosis and in 12 (23%) of the patients who were operated on for recurrences. The most frequent risk factors were: obesity, revised surgery and the physician’s low operative volume. Intraoperative dural fissures were repaired through suture (8 cases), by applying muscle, fat graft or by applying curaspon, tachosil. There existed 4 CSF fistulas which were repaired at reoperation. Incidental dural fissures during operations for degenerative lumbar disorders must be recognized and immediately repaired to prevent complications such as CSF fistula, osteodiscitis and increased medical costs. Preventing, identifying and treating unintentional durotomies can be best achieved by respecting a neat surgical technique and a standardized treatment protocol.


2018 ◽  
Vol 43 (4) ◽  
pp. 963-967 ◽  
Author(s):  
Eun-Ho Shin ◽  
Kyu-Jung Cho ◽  
Young-Tae Kim ◽  
Myung-Hoon Park

2016 ◽  
Vol 59 (2) ◽  
pp. 143 ◽  
Author(s):  
Jung Sik Bae ◽  
Kyung Hee Kang ◽  
Jeong Hyun Park ◽  
Jae Hyeon Lim ◽  
Il Tae Jang

2016 ◽  
Vol 24 (4) ◽  
pp. 592-601 ◽  
Author(s):  
Shota Takenaka ◽  
Kosuke Tateishi ◽  
Noboru Hosono ◽  
Yoshihiro Mukai ◽  
Takeshi Fuji

OBJECT In this study, the authors aimed to identify specific risk factors for postdecompression lumbar disc herniation (PDLDH) in patients who have not undergone discectomy and/or fusion. METHODS Between 2007 and 2012, 493 patients with lumbar spinal stenosis underwent bilateral partial laminectomy without discectomy and/or fusion in a single hospital. Eighteen patients (herniation group [H group]: 15 men, 3 women; mean age 65.1 years) developed acute sciatica as a result of PDLDH within 2 years after surgery. Ninety patients who did not develop postoperative acute sciatica were selected as a control group (C group: 75 men, 15 women; mean age 65.4 years). Patients in the C group were age and sex matched with those in the H group. The patients in the groups were also matched for decompression level, number of decompression levels, and surgery date. The radiographic variables measured included percentage of slippage, intervertebral angle, range of motion, lumbar lordosis, disc height, facet angle, extent of facet removal, facet degeneration, disc degeneration, and vertebral endplate degeneration. The threshold for PDLDH risk factors was evaluated using a continuous numerical variable and receiver operating characteristic curve analysis. The area under the curve was used to determine the diagnostic performance, and values greater than 0.75 were considered to represent good performance. RESULTS Multivariate analysis revealed that preoperative retrolisthesis during extension was the sole significant independent risk factor for PDLDH. The area under the curve for preoperative retrolisthesis during extension was 0.849; the cutoff value was estimated to be a retrolisthesis of 7.2% during extension. CONCLUSIONS The authors observed that bilateral partial laminectomy, performed along with the removal of the posterior support ligament, may not be suitable for lumbar spinal stenosis patients with preoperative retrolisthesis greater than 7.2% during extension.


2017 ◽  
Vol 9 (2) ◽  
pp. 202-209 ◽  
Author(s):  
Nicholas Shepard ◽  
Woojin Cho

Study Design: Narrative review. Objectives: To identify the risk factors and surgical management for recurrent lumbar disc herniation using a systematic review of available evidence. Methods: We conducted a review of PubMed, MEDLINE, OVID, and Cochrane Library databases using search terms identifying recurrent lumbar disc herniation and risk factors or surgical management. Abstracts of all identified articles were reviewed. Detailed information from articles with levels I to IV evidence was extracted and synthesized. Results: There is intermediate levels III to IV evidence detailing perioperative risk factors and the optimal surgical technique for recurrent lumbar disc herniations. Conclusions: Multiple risk factors including smoking, diabetes mellitus, obesity, intraoperative technique, and biomechanical factors may contribute to the development of recurrent disc disease. There is widespread variation regarding optimal surgical management for recurrent herniation, which often include revision discectomies with or without fusion via open and minimally invasive techniques.


2006 ◽  
Vol 6 (6) ◽  
pp. 684-691 ◽  
Author(s):  
Balraj S. Jhawar ◽  
Charles S. Fuchs ◽  
Graham A. Colditz ◽  
Meir J. Stampfer

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052097985
Author(s):  
Zeyue Jin ◽  
Hongzhi Lv ◽  
Ming Li ◽  
Zhiyong Hou ◽  
Xiaodong Lian ◽  
...  

Objective This study was performed to explore major risk factors for traumatic fracture by comparing related data of hospitalized patients with traumatic fracture and patients with lumbar disc herniation. Methods Patients with traumatic fracture and patients with lumbar disc herniation requiring surgical treatment in the orthopedics department of our hospital from March to May 2018 were divided into a fracture group and a non-fracture group. Clinical data were collected from the two groups by questionnaires. Major risk factors for traumatic fracture were analyzed using multivariate logistic regression. Results Univariate analysis showed statistically significant differences in family history of fracture, smoking history, drinking history, sex, sleep duration, chronic disease history, osteoporosis history, age, body mass index, occupation, and education level between the two groups. Multivariate logistic regression analysis showed that patients aged 25 to 44 years were more prone to traumatic fracture than patients aged ≥65 years, male patients were more prone to fracture than female patients, drinking alcohol was a risk factor for traumatic fracture, and sufficient sleep duration (>7 hours/night) was a protective factor for traumatic fracture. Conclusion Young age, male sex, and drinking are risk factors for traumatic fracture, whereas sufficient sleep duration is a protective factor.


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