Analysis Of The Correlative Factors Affecting The Incidence Of Intraoperative Dural Injury In Percutaneous Endoscopic Lumbar Discectomy

Objective:To explore the factors affecting the incidence of dural injury in percutaneous endoscopic lumbar discectomy(PELD),which guides the making of perioperative clinical decisions and improve the outcome of PELD.Methods:A retrospective analysis was performed on the patients with lumbar disc herniation(LDH)admitted to the Department of Spine,First Hospital of Jilin University from January 1,2017 to December 31,2018.And those were presented to PELD and matched with the inclusion criteria.The data of cases were collected on admission records and imaging:(1)Basic information such as age,gender,height and weight;(2)Physical examination data including preoperative symptoms and duration of symptoms;(3)Imaging data: preoperative magnetic resonance imaging(MRI)including herniation location,herniation type and herniation direction;postoperative MRI such as the intraoperative entry angle of working channel and the percentage of removed area of superior articular process during operation;(4)Surgical data included approach side and operative time;(5)Outcome indicators: the incidence of intraoperative dural injury.SPSS23.0 statistical software was used to analyze the risk factors of dural injury during PELD.Result:Fifty-eight patients were enrolled(60.3% female,mean age 46 years)in this study.Among the LDH patients received PELD,5 patients(8.6%)had intraoperative dural injury,neither did 53 patients(91.4%).The incidence of intraoperative dural injury was 8.6%.Univariate logistic regression analysis showed that the entry angle,area percentage and operative time might be the risk factors affecting the incidence of intraoperative dural sac injury.Multivariate logistic regression analysis demonstrated that the entry angle and area percentage were important risk factors affecting the incidence of intraoperative dural injury.The smaller the entry angle or the larger the area percentage,the higher the incidence of dural injury during operation.Conclusion:The incidence of dural injury in LDH patients received PELD at L4-5 level was 8.6%.The entry angle and area percentage were important risk factors affecting the incidence of intraoperative dural injury.The smaller the entry angle or the larger the area percentage,the higher the incidence of dural injury during operation.