Incidental Dural Tears during Lumbar Surgery: Incidence and Management

Object Transforaminal lumbar interbody fusion (TLIF) has been increasingly used to treat degenerative spine disease, including that in patients in whom earlier decompressive procedures have failed. Reexploration in these cases is always challenging and is thought to pose a higher risk of complications. To the best of the authors' knowledge, there are no current studies specifically analyzing the effects of previous lumbar decompressive surgeries on the complication rates of open TLIF. Methods The authors performed a retrospective study of surgeries performed by a single surgeon. A total of 187 consecutive patients, in whom the senior author (A.N.) had performed open TLIF between January 2007 and January 2011, met the inclusion criteria. The patients were divided into two groups (primary and revision TLIF) for the comparison of perioperative complications. Results Overall, the average age of the patients was 49.7 years (range 18–80 years). Of the 187 patients, 73 patients had no history of lumbar surgery and 114 were undergoing revision surgery. Fifty-four patients (28.9%) had a documented complication intraoperatively or postoperatively. There was no difference in the rate on perioperative complications between the two groups (overall, medical, wound related, inadvertent dural tears [DTs], or neural injury). Patients who had undergone more than one previous lumbar surgery were, however, more likely to have suffered from DTs (p = 0.054) and neural injuries (p = 0.007) compared with the rest. Conclusions In the hands of an experienced surgeon, revision open TLIF does not necessarily increase the risk of perioperative complications compared with primary TLIF. Two or more previous lumbar decompressive procedures, however, increase the risk of inadvertent DTs and neural injury.

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INVESTIGATION OF ANXIETY AND PAIN LEVELS OF PATIENTS AFTER LUMBAR SURGERY

10.26226/morressier.598b05d9d462b80290b53685 ◽

2017 ◽

Author(s):

Filiz Altug

Keyword(s):

Lumbar Surgery

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Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

Neurosurgical FOCUS ◽

10.3171/2020.6.focus20361 ◽

2020 ◽

Vol 49 (3) ◽

pp. E11 ◽

Cited By ~ 1

Author(s):

Yoshifumi Kudo ◽

Ichiro Okano ◽

Tomoaki Toyone ◽

Akira Matsuoka ◽

Hiroshi Maruyama ◽

...

Keyword(s):

Revision Surgery ◽

Spinal Canal ◽

Interbody Fusion ◽

Decompression Surgery ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Posterior Decompression ◽

Lateral Lumbar Interbody Fusion ◽

Significant Difference ◽

Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

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Minimally Invasive Posterior Lumbar Surgery in the Morbidly Obese, Obese and Non-Obese populations: A Single Institution Retrospective Review

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106746 ◽

2021 ◽

pp. 106746

Author(s):

Esteban Molina ◽

David Zhao ◽

Ehsan Dowlati ◽

Austin H. Carroll ◽

Kyle B. Mueller ◽

...

Keyword(s):

Minimally Invasive ◽

Retrospective Review ◽

Morbidly Obese ◽

Lumbar Surgery ◽

Single Institution

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The association between continuity of care and surgery in lumbar disc herniation patients

Scientific Reports ◽

10.1038/s41598-021-85064-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eun-San Kim ◽

Chang-yup Kim

Keyword(s):

Continuity Of Care ◽

Disc Herniation ◽

Structural Model ◽

Lumbar Disc ◽

Quality Care ◽

Target Population ◽

National Sample ◽

Marginal Structural Model ◽

Lumbar Surgery ◽

High Level

AbstractContinuity of care is a core dimension of high-quality care in the management of disease. The purpose of this study was to investigate the association between continuity of care and lumbar surgery in patients with moderate disc herniation. The Korean National Sample Cohort was used. The target population consisted of patients who have had disc herniation more than 6 months and didn’t get surgery and red flag signs within 6 months from onset. The population was enrolled from 2004 to 2013. The Bice-Boxerman Continuity of Care was used in measuring continuity of care. The marginal structural model with time dependent survival analysis was used. In total, 29,061 patients were enrolled in the cohort. High level of continuity of care was associated with a lower risk of lumbar surgery (HR, 0.27; 95% CI, 0.20–0.27). When the index was calculated only with outpatient visits to primary care with related specialty, the HR was 0.49 (95% CI: 0.43–0.57). In exploratory analysis, patients with lumbar stenosis and spondylolisthesis had higher risk of having a low level of continuity of care. These results indicate that continuity of care is associated with lower rates of lumbar surgery in patients with moderate disc herniation.

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