Related factors and management of cerebrospinal fluid leakage during degenerative lumbar spine surgery

English Keywords:Lumbar spinal surgery  Complications  Dural tears  Cerebrospinal fluid leakage

English Abstract:

  【Abstract】 Objectives: To analyze the related factors of the cerebrospinal fluid leakage after degenerative lumbar spine surgery, and to investigate the correpondent management. Methods: From January 2011 to December 2012, clinical and surgery records of patients undergoing spinal surgery in our institute were reviewed retrospectively. Pathogenesis included lumbar disc herniation(LDH), lumbar spinal stenosis(LSS), lumbar spondylolisthesis(LS) and lumbar degenerative scoliosis/kyphosis(LDS). Data of gender, age, body mass index(BMI), diagnosis, revision surgery, surgical method, number of surgical levels, fusion method, amount of drain output, drain duration and management of cerebrospinal fluid leakage(CSFL) were collected. 3 cases as control without CSFL were randomly selected from the same database. Results: A total of 1425 degenerative lumbar spine surgical cases were collected, including 675 males and 750 females, and the mean age at surgery was 54.5±13.1(16-80) years. There were 378 LDH, 647 LSS, 304 LS and 96 LDS; 1351 primary surgery and 74 revision surgery; 635 one-level decompression, 491 two-level decompression, 204 three-level decompression and 95 with decompression of more than three levels decompression. Among these cases, 57(4.0%) cases were complicated with CSFL, including 7 LDH(1.9%), 30 LSS(4.6%), 13 LS(4.3%) and 7 LDS(7.3%), there was no significant difference(P>0.05) among them. The rate of CSFL was 12.2% for revision surgery and 3.6% for primary surgery, which showed significant difference(P<0.05) between them. The incidence of CSFL for decompression of more than three levels was 13.7%, which was higher than 1.9% for one level, 3.7% for two levels and 6.9% for three levels. A multivariate logistic regression analysis demonstrated that revision surgery and more than decompressed 3 levels were risk factors for CSFL. For CSFL patients treated with antibiostic intervention, position adjustment, closed wound drainage for an average of 5.6 days and bed rest for 6-7 days, no case presented with wound infection, pseudomeningocele or cerebrospinal fluid fistula formation. Conclusions: Revision surgery and more than decompressed three levels are the risk factors for post-operative CSFL. It is a safe protocol for post-operative drainage for 5-6 days.