The October 2024 Spine Roundup. 360. looks at: Analysis of risk factors for non-fusion of bone graft in anterior cervical discectomy and fusion: a clinical retrospective study; Does paraspinal muscle mass predict lumbar lordosis before and after decompression for degenerative spinal stenosis?; Return to work after surgery for
The aim of this study was to explore risk factors for complications associated with dural tear (DT), including the types of DT, and the intra- and postoperative management of DT. Between 2012 and 2017, 12 171 patients with degenerative lumbar diseases underwent primary lumbar spine surgery. We investigated five categories of potential predictors: patient factors (sex, age, body mass index, and primary disease), surgical factors (surgical procedures, operative time, and estimated blood loss), types of DT (inaccessible for suturing/clipping and the presence of cauda equina/nerve root herniation), repair techniques (suturing, clipping, fibrin glue, polyethylene glycol (PEG) hydrogel, and polyglycolic acid sheet), and postoperative management (drainage duration). Postoperative complications were evaluated in terms of dural leak, prolonged bed rest, headache, nausea/vomiting, delayed wound healing, postoperative neurological deficit, surgical site infection (SSI), and reoperation for DT. We performed multivariable regression analyses to evaluate the predictors of postoperative complications associated with DT.Aims
Patients and Methods
We estimated the long term results of the different methods in chirurgical treatment of
Aim: Evaluate the preoperative prognostic factors of a poor result in conventional surgery of lumbar disc herniation. Methods: From November 1995 to November 2001, we performed 113 standard discectomies (63 males/50 females) with a mean-age of 42 years (21–75). All patients had been evaluated preoperatively with X-ray and C.T. scan. Fifty-nine patients (52%) had a preoperative M.R.I., and an evaluation was made of disk degeneration degree, multilevel degeneration and bone changes in vertebral end-plates (according Modic classiþcation). The postoperative mean follow-up was 46,2 months. The outcomes were evaluated considering the reoperation rate, the intensity of pain in the Visual Analogue Score, and þnal function with the Oswestry Disability Index. The results were compared using ANOVA. Results: We have found a statistical correlation between a poor result and older age (p=0.006), diabetes (p=0.005), psychological factors (p=0.006) and preoperative X-ray changes, such as disk height loss greater than a third (p<
0.001), subcondral sclerosis (p<
0.001), segmental instability (p=0.019) and ostheo-arthritis (p<
0.001). Regarding M.R.I., the multilevel degeneration and the Modic changes (type I, II or III) have been correlated in this study with poor functional result (p=0.004 and p<
0.001 respectively). Conclusions: Our results support the concept that in patients with