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Abstract：
BACKGROUND: An unintended dural tear (DT) is the most common intraoperative complication of lumbar spine surgery. The unilateral biportal endoscopic technique (UBE) has become increasingly popular for treating various degenerative diseases of the lumbar spine; however, the DT incidence and risk factors specific to UBE remain undetermined. Therefore, this study aimed to evaluate the incidence and risk factors of DTs in UBE.
METHODS: Data from all patients who underwent UBE for degenerative lumbar spinal diseases from November 2018 to December 2021 at our institution were used to assess the effects of demographics, diagnosis, and type of surgery on unintended DT risk.
RESULTS: Overall, 24/608 patients (3.95%) experienced DTs and were treated with primary suture repair or bed rest. Although several patients experienced mild symptoms of cerebrospinal fluid (CSF) leaks, no serious postoperative sequelae such as nerve root entrapment, meningitis, or intracranial hemorrhage occurred. Additionally, no significant correlations were identified between DT and sex (P = 0.882), body mass index (BMI) (P = 0.758), smoking status (P = 0.506), diabetes (P = 0.672), hypertension (P = 0.187), or surgeon experience (P = 0.442). However, older patients were more likely to experience DT than younger patients (P = 0.034), and patients with lumbar spinal stenosis (LSS) were more likely to experience DT than patients with lumbar disc herniation (LDH) (P = 0.035). Additionally, DT was more common in revision versus primary surgery (P < 0.0001) and in unilateral laminotomy with bilateral decompression (ULBD) versus unilateral decompression (P = 0.031). Univariate logistic regression analysis revealed that age, LSS, ULBD, and revision surgery were significant risk factors for DT.
CONCLUSIONS: In this UBE cohort, we found that the incidence of DT was 3.95%. Additionally, older age, LSS, ULBD, and revision surgery significantly increased the risk of DT in UBE surgery.
METHODS: Data from all patients who underwent UBE for degenerative lumbar spinal diseases from November 2018 to December 2021 at our institution were used to assess the effects of demographics, diagnosis, and type of surgery on unintended DT risk.
RESULTS: Overall, 24/608 patients (3.95%) experienced DTs and were treated with primary suture repair or bed rest. Although several patients experienced mild symptoms of cerebrospinal fluid (CSF) leaks, no serious postoperative sequelae such as nerve root entrapment, meningitis, or intracranial hemorrhage occurred. Additionally, no significant correlations were identified between DT and sex (P = 0.882), body mass index (BMI) (P = 0.758), smoking status (P = 0.506), diabetes (P = 0.672), hypertension (P = 0.187), or surgeon experience (P = 0.442). However, older patients were more likely to experience DT than younger patients (P = 0.034), and patients with lumbar spinal stenosis (LSS) were more likely to experience DT than patients with lumbar disc herniation (LDH) (P = 0.035). Additionally, DT was more common in revision versus primary surgery (P < 0.0001) and in unilateral laminotomy with bilateral decompression (ULBD) versus unilateral decompression (P = 0.031). Univariate logistic regression analysis revealed that age, LSS, ULBD, and revision surgery were significant risk factors for DT.
CONCLUSIONS: In this UBE cohort, we found that the incidence of DT was 3.95%. Additionally, older age, LSS, ULBD, and revision surgery significantly increased the risk of DT in UBE surgery.
摘要：
背景：意外的硬脑膜撕裂（DT）是腰椎手术中最常见的术中并发症。单侧双门内窥镜技术(UBE)在治疗各种腰椎退行性疾病中日益普及;然而,UBE特有的DT发生率和危险因素仍未确定.因此,本研究旨在评估DTs在UBE中的发生率和危险因素。
方法：使用2018年11月至2021年12月在我们机构接受UBE治疗退行性腰椎疾病的所有患者的数据来评估人口统计学的影响，诊断,以及意外DT风险的手术类型。
结果：总体而言，24/608名患者（3.95％）经历了DTs，并接受了初次缝合修复或卧床休息治疗。尽管有几名患者出现了脑脊液（CSF）泄漏的轻度症状，没有严重的术后后遗症，如神经根卡压，脑膜炎,或颅内出血。此外,DT和性别之间没有发现显著的相关性(P=0.882)，体重指数(BMI)(P=0.758),吸烟状况（P=0.506），糖尿病（P=0.672），高血压（P=0.187），或外科医生经验（P=0.442）。然而,老年患者比年轻患者更容易经历DT(P=0.034)，与腰椎间盘突出症（LDH）患者相比，腰椎管狭窄（LSS）患者更容易发生DT（P=0.035）。此外,DT在翻修术和初次手术中更为常见（P<0.0001），在双侧减压的单侧椎板切开术（ULBD）和单侧减压术中更为常见（P=0.031）。单因素Logistic回归分析显示，年龄，LSS,ULBD,和翻修手术是DT的重要危险因素。
结论：在此UBE队列中，我们发现DT的发病率为3.95%。此外,年龄较大,LSS,ULBD,修正手术显著增加了UBE手术中DT的风险。
方法：使用2018年11月至2021年12月在我们机构接受UBE治疗退行性腰椎疾病的所有患者的数据来评估人口统计学的影响，诊断,以及意外DT风险的手术类型。
结果：总体而言，24/608名患者（3.95％）经历了DTs，并接受了初次缝合修复或卧床休息治疗。尽管有几名患者出现了脑脊液（CSF）泄漏的轻度症状，没有严重的术后后遗症，如神经根卡压，脑膜炎,或颅内出血。此外,DT和性别之间没有发现显著的相关性(P=0.882)，体重指数(BMI)(P=0.758),吸烟状况（P=0.506），糖尿病（P=0.672），高血压（P=0.187），或外科医生经验（P=0.442）。然而,老年患者比年轻患者更容易经历DT(P=0.034)，与腰椎间盘突出症（LDH）患者相比，腰椎管狭窄（LSS）患者更容易发生DT（P=0.035）。此外,DT在翻修术和初次手术中更为常见（P<0.0001），在双侧减压的单侧椎板切开术（ULBD）和单侧减压术中更为常见（P=0.031）。单因素Logistic回归分析显示，年龄，LSS,ULBD,和翻修手术是DT的重要危险因素。
结论：在此UBE队列中，我们发现DT的发病率为3.95%。此外,年龄较大,LSS,ULBD,修正手术显著增加了UBE手术中DT的风险。
