Intraoperative Management of Iatrogenic Durotomy in Endoscopic Spine Surgery: A Systematic Review.

IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Neurospine Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI:10.14245/ns.2448346.173
Warayos Trathitephun, Akarawit Asawasaksakul, Khananut Jaruwanneechai, Boonserm Pakdeenit, Abhirat Suebsing, Yanting Liu, Jin-Sung Kim, Siravich Suvithayasiri
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Abstract

This review aims to systematically evaluate the incidence, management strategies, and clinical outcomes of iatrogenic durotomy (ID) in endoscopic spine surgery and to propose a management flowchart based on the tear size and associated complications. A comprehensive literature search was conducted, focusing on studies involving endoscopic spinal procedures and incidental durotomy. The selected studies were analyzed for management techniques and outcomes, particularly in relation to the size of the dural tear and the presence of nerve root herniation. Based on these findings, a flowchart for intraoperative management was developed. A total of 14 studies were included, encompassing 68,546 patients. Varying incidences of ID, with management strategies largely dependent on the size of the dural tear, were found. Small tears (less than 5 mm) were often left untreated or managed with absorbable hemostatic agents, while medium (5-10 mm) and large tears (greater than 10 mm) required more complex approaches like endoscopic patch repair or open surgery. The presence of nerve root herniation necessitated immediate action, often influencing the decision to convert to open repair. Effective management of ID in endoscopic spine surgery requires a nuanced approach tailored to the size of the tear and specific intraoperative challenges, such as nerve root herniation. The proposed flowchart offers a structured approach to these complexities, potentially enhancing clinical outcomes and reducing complication rates. Future research with more rigorous methodologies is necessary to refine these management strategies further and broaden the applications of endoscopic spine surgery.

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内窥镜脊柱手术中对先天性硬膜切开术的术中处理:系统回顾
本综述旨在系统评估内窥镜脊柱手术中先天性硬膜切开术(ID)的发生率、处理策略和临床结果,并根据撕裂大小和相关并发症提出处理流程图。研究人员进行了全面的文献检索,重点关注涉及内窥镜脊柱手术和意外硬膜切开术的研究。对所选研究的管理技术和结果进行了分析,尤其是与硬脊膜撕裂的大小和是否存在神经根疝相关的内容。根据这些研究结果,制定了术中管理流程图。共纳入了 14 项研究,涉及 68546 名患者。研究发现,硬膜外撕裂的发生率各不相同,管理策略主要取决于硬膜撕裂的大小。小的撕裂(小于 5 毫米)通常不做处理,或用可吸收止血剂处理,而中等(5-10 毫米)和大的撕裂(大于 10 毫米)则需要更复杂的方法,如内窥镜补片修复或开放手术。神经根疝的出现需要立即采取行动,这往往会影响到转为开放性修复的决定。在内窥镜脊柱手术中有效处理 ID 需要根据撕裂的大小和术中面临的具体挑战(如神经根疝出)采取细致入微的方法。所建议的流程图为解决这些复杂问题提供了一种结构化的方法,有可能提高临床效果并降低并发症发生率。未来有必要采用更严格的方法进行研究,进一步完善这些管理策略,扩大内窥镜脊柱手术的应用范围。
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来源期刊
Neurospine
Neurospine Multiple-
CiteScore
5.80
自引率
18.80%
发文量
93
审稿时长
10 weeks
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