背景:与开放脊柱手术相比,内窥镜脊柱手术(ESS)的偶发性硬骨切开术(ID)的发生率降低。然而,由于单一,在ESS中管理ID存在独特的挑战,深,狭窄的工作走廊和水环境。这里,我们提出了一种胶原基质嵌体移植技术,用于处理ESS期间遇到的ID。
方法:通过完整ESS的病历回顾确定了3例患者,其中发现了术中ID。这些都是通过内窥镜解决的。在2019年至2023年,所有手术均由一名外科医生进行。病人,Operative,和术后细节,包括患者报告的结果,被记录下来。简而言之,胶原基质镶嵌移植技术包括将一部分胶原基质引入手术区域,并操纵胶原基质,使其通过硬膜切开术并留在硬脑膜内,堵塞孔。
结果:在总共295例符合条件的病例中确定了3个ID(1.02%)。测量的ID长度为2至2.5mm。对于这三个患者来说,住院时间为172至1,068分钟.在任何术后时间点,没有患者表现出脑脊液漏的体征或症状。在术后6周的访视中,所有患者的Oswestry残疾指数均达到最小临床重要差异,所有具有可用的腿部和下腰痛视觉模拟量表评分的患者均达到了最小临床重要差异的临界值.
结论:我们介绍了3例单通道完整ESS中使用胶原基质嵌体技术修复的ID。避免了长时间卧床休息,所有患者均取得了优异的临床疗效,无进一步并发症发生.该技术也可以适用于其他微创脊柱手术技术。
结论:ID是腰椎退变性手术中常见且不良的并发症。内窥镜ID修复技术提供了一种选择,可以避免转换为开放或管状手术来管理ID。
方法:
BACKGROUND: Endoscopic spine surgery (ESS) has a reduced rate of incidental durotomy (ID) compared with open spine surgery. However, there are unique challenges regarding the management of ID in ESS due to the single, deep, narrow working corridor and aqueous environment. Here, we present a collagen matrix inlay graft technique for the management of ID encountered during ESS.
METHODS: Three patients were identified via medical record review of full ESS where an intraoperative ID was encountered. These were all addressed endoscopically. All surgeries were performed by a single surgeon in the years 2019 to 2023. Patient, operative, and postoperative details, including patient-reported outcomes, were recorded. Briefly, the collagen matrix inlay graft technique included introducing a segment of collagen matrix into the surgical field and manipulating the collagen matrix so that it passed through the durotomy and resided within the dura, plugging the hole.
RESULTS: Three IDs were identified out of a total of 295 eligible cases (1.02%). The IDs measured 2 to 2.5 mm in length. For these 3 patients, the duration of hospital stay ranged from 172 to 1,068 minutes. No patients exhibited signs or symptoms of cerebrospinal fluid leak at any postoperative timepoint. At the 6-week postoperative visit, all patients had achieved the minimum clinically important difference in Oswestry Disability Index, and all patients with available visual analog scale scores for leg and low back pain had achieved the cutoff for the minimum clinically important difference.
CONCLUSIONS: We presented 3 cases of ID during uniportal full ESS who were repaired using a collagen matrix inlay technique. Prolonged bed rest was avoided, and all patients achieved excellent clinical outcomes without further complication. This technique may also be appropriate for other minimally invasive spine surgery techniques.
CONCLUSIONS: ID is a common and undesirable complication of degenerative lumbar spine surgery. Endoscopic ID repair techniques provide an option to avoid conversion to open or tubular surgery for the management of ID.
METHODS: