Lomber Mikrocerrahi ile Diskektomi Yapılan Hastalarda Tesadüfi Dural Yırtık Prognozunun İncelenmesi; Tek Merkezli Retrospektif Analiz

Yıl 2025, Cilt: 22 Sayı: 1, 79 - 84, 26.03.2025

Atakan Besnek , Muhammed Erkan Emrahoğlu

https://doi.org/10.35440/hutfd.1495296

Öz

Amaç: Dural yırtık, lomber diskektomi sırasında en sık görülen komplikasyondur. Ek komplikasyonlara yol açabilmektedir. Çalışmamızda lomber mikrocerrahi yaptığımız hastalarda dural yırtık görülme oranını, risk faktörlerini, intraoperatif dural yırtık gelişenlerde uyguladığımız yöntemleri ve postoperat-if komplikasyonları inceledik.
Materyal ve metod: Çalışmamızda hastanemizde lomber mikrocerrahi diskektomi yapılan 1845 hasta incelendi. Hastaların hangi seviyeden ve hangi taraftan opere edildikleri ve nüks diskektomi yapılıp yapılmadığı, dural yırtık gelişip gelişmediği kayıt altına alınmıştır. İntraoperatif ve postoperatif süreçler sorgulanarak istatistiki analize tabi tutulmuştur.
Bulgular: 1845 hastanın 171’inde dural yırtık gelişmiştir. Dural yırtık gelişen hastalarda yaş ortalaması 53 olarak tespit edilmiş, dural yırtık gelişmeyen hastalara göre anlamlı olarak yüksek bulunmuştur. (p<0,001) Bilateral diskektomi yapılan hastalarda dural yırtık gelişme oranı anlamlı olarak yüksek bu-lunmuştur. (p<0,001) Hastaların operasyon seviyeleri incelendiğinde L4-5 mesafesinden ve birden çok seviyeden yapılan operasyonlar ile nüks diskektomilerde dural yırtık gelişme oranı anlamlı olarak yük-sek bulunmuştır. (p<0,001) Dural yırtık gelişen 171 hastanın 19’unda çeşitli sebepler ile tekrar yatış ya da reoperasyon ihtiyacı olmuştur.
Sonuç: Dural yırtık sonuçları itibariyle nöroşirurjiyenler için korkutucu bir komplikasyondur. Elde etti-ğimiz sonuçlar dural yırtığın risk faktörleri olarak, artan yaş, L4-5 seviyesinden yapılan operasyonlar, bilateral ve çok seviye operasyonlar ile nüks operasyonları tespit etmiştir. Dural yırtık sonrası reope-rasyon veya yeniden yatış gereksinimi üzerine, intraoperatif primer sütürasyon, doku grefti veya doku yapıştırıcısı uygulamanın anlamlı farklılıklar oluşturmadığını tespit ettik.

Anahtar Kelimeler

Dural yırtık, Spinal cerrahi, Beyin omurilik sıvısı(BOS) kaçağı

Prognosis of Incidental Dural Tear in Patients Who Underwent Lumbar Discectomy With Microsurgery; A Single Center Retrospective Analysis

Öz

Background: Dural tear is the most common complication during lumbar discectomy. It may lead to additional complications. In our study, we examined the incidence of dural tears in patients undergo-ing lumbar microsurgery, the risk factors, the methods we used in cases with intraoperative dural tears, and the postoperative complications.
Materials and Methods: In our study, 1845 patients who underwent lumbar microdiscectomy at our hospital were examined. The level and side of the surgery, as well as whether revision discectomy was performed and whether a dural tear occurred, were recorded. Intraoperative and postoperative pro-cesses were investigated and subjected to statistical analysis.
Results: In 171 out of 1845 patients, a dural tear occurred. The average age of patients with dural tears was found to be 53, which was significantly higher compared to patients without dural tears. (p<0,001) The rate of dural tears was significantly higher in patients who underwent bilateral dis-cectomy. (p<0,001) When examining the operation levels, the rate of dural tears was significantly higher in surgeries performed at the L4-5 level, multiple levels, and in revision discectomies. (p<0,001) Among the 171 patients who experienced a dural tear, 19 required rehospitalization or reoperation for various reasons.
Conclusions: Dural tears are a frightening complication for neurosurgeons due to their potential out-comes. Our results identified increasing age, surgeries performed at the L4-5 level, bilateral and mul-tiple level surgeries, and revision surgeries as risk factors for dural tears. Regarding the need for reo-peration or rehospitalization following a dural tear, we found no significant differences between the application of intraoperative primary suturing, tissue grafts, or tissue adhesives.

Kaynakça

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