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杨 意, 张 扬, 雷 伟. [Research status of dural injury types and repair]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1177-1182. [PMID: 37718434 PMCID: PMC10505634 DOI: 10.7507/1002-1892.202306064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/31/2023] [Indexed: 09/19/2023]
Abstract
Objective To evaluate the current status of classification and repair methods for dural injury caused by spinal surgery or trauma, providing new strategies and ideas for the clinical repair of dural injury and the development of related materials. Methods The literature related to dural injury both at home and abroad in recent years was thoroughly reviewed and analyzed in order to draw meaningful conclusions. Results There have been numerous retrospective studies on dural injury, but there is a scarcity of prospective and multi-center studies, resulting in a low level of evidence-based research. The incidence and risk factors of dural injury have primarily been studied in relation to common degenerative spinal diseases of the cervical and lumbar spine, with insufficient research on thoracic spine-related diseases. Currently, a universally recognized method for grading and classifying dural injury has not been established, which hampers the development of clinical guidelines for their repair. Furthermore, although there are repair materials and surgical strategies available to address clinical issues such as suture leakage and surgical repair of dural injury in complex locations, there is a lack of comprehensive clinical research and evidence-based data to validate their scientificity and reliability. Conclusion Regardless of the classification of dural injury, suture remains the most important repair method. It is important to further develop new patches or sealants that can meet clinical needs and reduce the difficulty of repair.
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Affiliation(s)
- 意鹏 杨
- 空军军医大学第一附属医院骨科(西安 710032)Department of Orthopedics, the First Affiliated Hospital of Air Force Medical University, Xi’an Shaanxi, 710032, P. R. China
| | - 扬 张
- 空军军医大学第一附属医院骨科(西安 710032)Department of Orthopedics, the First Affiliated Hospital of Air Force Medical University, Xi’an Shaanxi, 710032, P. R. China
| | - 伟 雷
- 空军军医大学第一附属医院骨科(西安 710032)Department of Orthopedics, the First Affiliated Hospital of Air Force Medical University, Xi’an Shaanxi, 710032, P. R. China
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Yavuz A, Gok H, Yangi K, Celik SE, Percinoglu G, Goksu K. High-Frequency Bipolar Coagulation Limits Epidural Fibrosis in Lumbar Microdiscectomy. Cureus 2023; 15:e45077. [PMID: 37705564 PMCID: PMC10495867 DOI: 10.7759/cureus.45077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND AIM We propose a vast study to examine the effect of high-frequency bipolar coagulation used in the operating room to prevent the development of epidural fibrosis after lumbar microdiscectomy. MATERIALS AND METHODS A total of 1004 participants were divided into two groups: no high-frequency bipolar coagulation (NC group) and high-frequency bipolar coagulation (C group). Postoperative epidural fibrosis, infection rates, reoperation status, and dural injury complications during the operation were recorded. RESULTS Considering the epidural fibrosis rates of the two groups, epidural fibrosis was seen in 10.6% of the patients in the NC group. In contrast, it was seen in only 6.2% of the patients in the C group. CONCLUSION The complication of epidural fibrosis that develops after lumbar microsurgery operations both impairs patient comfort and brings with it the complications of reoperation. After performing hemostasis with bipolar, coagulating the annulus may effectively reduce epidural fibrosis and prevent reoperation.
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Affiliation(s)
- Ahmed Yavuz
- Neurosurgery, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, TUR
| | - Haydar Gok
- Neurological Surgery, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, TUR
| | - Kivanc Yangi
- Neurological Surgery, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, TUR
| | - Suat Erol Celik
- Neurological Surgery, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, TUR
| | - Gokhan Percinoglu
- Neurological Surgery, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, TUR
| | - Kamber Goksu
- Radiology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
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Sato S, Hayashi H, Urayama D, Ito Y, Naganuma H, Shinbori H. A Case of Remote Cerebellar Hemorrhage in Spinal Surgery without Dural Injury: Case Report. J Orthop Case Rep 2023; 13:38-41. [PMID: 37753124 PMCID: PMC10519310 DOI: 10.13107/jocr.2023.v13.i09.3868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/19/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Remote cerebellar hemorrhage (RCH) has been reported as a serious complication of spine surgery and is considered to be caused by dural injury. However, we have experienced a case in which intracranial hemorrhage occurred immediately after lumbar spine surgery without dural tear. There were no reports of RCH in spinal surgery without dural injury as far as we could find. Case Report We described a rare presentation of an 80-year-old male who suffered a loss of consciousness after lumbar surgery. He was diagnosed with impaired consciousness due to chronic and acute intracranial hemorrhage. He went through two hematoma removal surgeries and his consciousness improved. Conclusion RCH can occur in spinal surgery in patients with predicted cerebrovascular fragility, even in the absence of dural injury. Pre-operative imaging evaluation could be useful in assessing cerebrovascular fragility.
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Affiliation(s)
- Shinsuke Sato
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
| | - Hiroshi Hayashi
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
| | - Daiki Urayama
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
| | - Yusuke Ito
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
| | - Hidetoshi Naganuma
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
| | - Hiroshi Shinbori
- Department of Orthopedic Surgery, Ibaraki Prefectural Central Hospital, Kasama Shi, Ibaraki Ken, 309 1703, Japan
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Takigawa T, Morita T, Taoka T, Ishihara T, Ito Y. Pneumocephalus After Anterior Lumbar Spinal Surgery Due to Trauma: A Case Report. Cureus 2023; 15:e37726. [PMID: 37206497 PMCID: PMC10191756 DOI: 10.7759/cureus.37726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/21/2023] Open
Abstract
Pneumocephalus as a complication of anterior lumbar spinal surgery is extremely rare. A 53-year-old male patient presented with L4 fracture. Posterior fixation from L3 to L5 was conducted one day after the trauma. As the patient's neurological deficit persisted, additional anterior surgery by L4 vertebral body replacement was performed on the 19th day. Both surgeries were completed without obvious intraoperative complications. Two weeks after the anterior lumbar surgery, the patient complained of severe headaches, and computed tomography scan revealed pneumocephalus and massive fluid retention in the abdomen. The symptoms improved with conservative treatment, including bed rest, spinal drainage, intravenous drip infusion, and prophylactic administration of antibiotics. Due to the lack of tamponade effect in the soft tissues, a large amount of cerebrospinal fluid leakage may induce and cause progression of pneumocephalus in anterior dural injury.
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Affiliation(s)
- Tomoyuki Takigawa
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Kobe, JPN
| | - Takuya Morita
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Kobe, JPN
| | - Takuya Taoka
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Kobe, JPN
| | - Takeshi Ishihara
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Kobe, JPN
| | - Yasuo Ito
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Kobe, JPN
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Haddas R, Boah A. The H Laminectomy: Technical Description and Clinical Experience From the First 85 Patients. Int J Spine Surg 2023; 17:69-75. [PMID: 36574988 PMCID: PMC10025847 DOI: 10.14444/8383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Over the years, lumbar laminectomy has been widely employed by spinal surgeons for many purposes throughout the spinal canal. The Misonix BoneScalpel relies on ultrasonic energy and allows the surgeon to make precise osteotomies while protecting collateral or adjacent soft tissue structures. Amplification of electric impulses allows the blade in the BoneScalpel to oscillate at very high frequencies, which thus allow it to cut bone with immense amounts of heat, which are then tempered with copious irrigation to prevent overheating. The purpose of this study is to outline and detail an innovative technique while providing insight into the technique's clinical application in a variety of spine surgeries. METHODS Data were retrospectively collected from medical charts and surgical reports from February 2018 to July 2021 for each surgery in which the ultrasonic scalpel was used to perform the H laminectomy. Baseline demographic information was recorded, including age, gender, laminectomy indication, and the number of levels of laminectomy. RESULTS A total of 85 patients (64 women, 21 men) were included in this study. The mean age of the patients was 63.7 years. Of those patients, 42.4% underwent H laminectomy for degenerative stenosis without instrumentation, 31.8% for degenerative stenosis with instrumentation, 9.4% for traumatic injuries, and 7.1% for revision surgery with instrumentation. Approximately 55% of patients underwent laminectomy of 2 or more levels, while the rest underwent single-level laminectomy. No patients had a dural tear or cerebrospinal fluid (CSF) leak as a result of the BoneScalpel. CONCLUSIONS The H laminectomy is another safe and effective way to perform a lumbar laminectomy. The technique has not been previously reported in the literature. No patients experienced a dural tear or CSF leak from the BoneScalpel using the H laminectomy technique. This technique affords the surgeon enhanced control of the dura-ligamentum interface. Even if the surgeon is not very experienced with the BoneScalpel, this technique provides an inherent safety mechanism with constant visualization/tactile feedback of the tip of the instrument and osteotome. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Ram Haddas
- University of Rochester Medical Center, Rochester, NY, USA
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Miyaoka Y, Uehara M, Oba H, Kamanaka T, Ikegami S, Kuraishi S, Futatsugi T, Tsutsumimoto T, Kaneko T, Fujinaga Y, Nakao S, Kodaira M, Sekijima Y, Maruyama T, Hamano Y, Ichikawa M, Imamura H, Kuroiwa M, Horiuchi T, Tanaka S, Kawamata M, Takahashi J. Pseudohypoxic brain swelling and secondary hydrocephalus with pseudomeningocele after lumbar surgery: a case report. Br J Neurosurg 2021:1-6. [PMID: 34553665 DOI: 10.1080/02688697.2021.1958157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/24/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postoperative intracranial complications are rare in spine surgery not including cranial procedures. We describe an uncommon case of pseudohypoxic brain swelling (PHBS) and secondary hydrocephalus after transforaminal lumbar interbody fusion (TLIF) presenting as impaired consciousness and repeated seizures. CASE PRESENTATION A 65-year-old man underwent L4-5 TLIF for lumbar spondylolisthesis and began experiencing generalized seizures immediately postoperatively. Computed tomography (CT) revealed diffuse cerebral edema-like hypoxic ischemic encephalopathy. He was transported to our hospital, at which time epidural drainage was halted and anti-edema therapy was commenced. His impaired consciousness improved. However, he suffered secondary hydrocephalus due to continuous bleeding from a dural defect and spinal epidural fluid collection 3 months later. Following the completion of dural repair and insertion of a ventriculoperitoneal shunt, his neurologic symptoms and neuroimaging findings improved significantly. CONCLUSIONS PHBS can be considered in patients with unexpected neurological deterioration following lumbar spine surgery even with the absence of documented durotomy. This might be due to postoperative intracranial hypotension-associated venous congestion, and to be distinguished from the more common postoperative cerebral ischemic events-caused by arterial or venous occlusions-or anesthetics complications.
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Affiliation(s)
- Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Takayuki Kamanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shugo Kuraishi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | | | | | - Tomoki Kaneko
- Department of Radiology, Shinshu University School of Medicine, Nagano, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Nagano, Japan
| | - Satoshi Nakao
- Department of Medicine, Neurology and Rheumatology, Shinshu University School of Medicine, Nagano, Japan
| | - Minori Kodaira
- Department of Medicine, Neurology and Rheumatology, Shinshu University School of Medicine, Nagano, Japan
| | - Yoshiki Sekijima
- Department of Medicine, Neurology and Rheumatology, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Maruyama
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Yujiro Hamano
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Michitaro Ichikawa
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroshi Imamura
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Masafumi Kuroiwa
- Department of Neurosurgery, Shinshu University School of Medicine, Nagano, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Nagano, Japan
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Nagano, Japan
| | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
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Abstract
STUDY DESIGN Retrospective study. OBJECTIVES Unilateral biportal endoscopic surgery (UBES) is a popular surgical method used to treat degenerative spinal diseases because of its merits, such as reduced tissue damage and outstanding visual capacity. However, dural injury is the most common complication of UBES with an incidence rate of 1.9% to 5.8%. The purpose of this study was to analyze the pattern of dural injury during UBES and to report the clinical course. METHODS We retrospectively reviewed the medical and radiographic records of surgically treated patients who underwent UBES at a single institute between January 2018 and December 2019. RESULTS Fifty-three patients, representing 67 segments, underwent UBES. Seven dural injuries occurred, and the incidence rate was 13.2%. Among 16 far lateral approaches, 2 dural injuries of the exiting roots occurred and were treated with fibrin sealant reinforcement. Among 51 median approaches, dural injury occurred at the thecal sac (n = 3) and traversing root (n = 2). A dural injury of the shoulder of the traversing root was treated with a fibrin sealant; however, a defect in the thecal sac required a revision for reconstruction. The other 2 thecal sac injuries were directly repaired via microscopic surgery. CONCLUSIONS Dural injury during UBES can occur because of the various anatomical features of the meningo-vertebral ligaments. Direct repair of the central dural defect should be considered under microscopic vision. A linear tear in the lateral dura or root can be controlled with a simple patchy reinforcement under endoscopic vision.
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Affiliation(s)
- Han Gyu Lee
- Catholic Kwandong University, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Moo Sung Kang
- H plus Yangji Hospital, Seoul, Republic of Korea,Moo Sung Kang, MD, Department of Neurosurgery, H plus Yangji Hospital, 1640, Nambusunhwan-ro, Gwanak-gu, Seoul, Republic of Korea 08779.
| | - So Yeon Kim
- Catholic Kwandong University, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Kwang Chun Cho
- Catholic Kwandong University, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Young Cheol Na
- Catholic Kwandong University, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jin Mo Cho
- Catholic Kwandong University, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Byung Ho Jin
- Catholic Kwandong University, International St. Mary’s Hospital, Incheon, Republic of Korea
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