Incidence & Management of Delayed Cerebrospinal Fluid Leaks after Lumbar Spinal Surgery-Analysis of 10 Cases
DOI:
https://doi.org/10.36552/pjns.v23i3.363Keywords:
Lumbar spine, cerebrospinal fluid leak,Abstract
Objectives: Cerebrospinal fluid (CSF) leaks in degenerative lumbar spine surgery are common, however, delayed cerebrospinal fluid (CSF) leaks are quite rare in neurosurgical practice. Literature regarding its incidence and management is scant.Our aim was to describe the incidence & management of delayed CSF leaks after degenerative lumbar spine surgery.
Material & Methods: This was a prospective study where all patients operated for lumbar disc or stenosis, who presented with the delayed CSF leak (> 1 week postoperatively) without intraoperative record of incidental durotomy were included. Data was collected about demographics, diagnosis, operative detail, postoperative course & management issues.
Results: Ten out of 1128 patients developed delayed CSF leaks (0.89%). Mean age at the time of diagnosis was 52.1 ± 6.9 years with 6 (60%) males & 4 (40%) female. The most common spinal level was L5-S1 (50%). Eighty percent (n = 8) patients underwent primary surgery while 20% (n = 2) were revisions. Clinical features were headaches (80%), dizziness (70%) and altered sensorium in 20%. Mean time of the leak was 17.3 ± 2.2 days. Two patients resolved with bed rest and compression dressing while the lumbar drain was placed in 80%. Three (30%) patients of the 8 needed open repair of the dural defect. Complications of the CSF leak included wound infection in 60%, and meningitis in one (10%) patient. There were no cases of neurologic deficit. One case eventually developed infective discitis.
References
2. Galarza M, Gazzeri R, Alfaro R, de la Rosa P, Arraez C, Piqueras C. Evaluation and management of small dural tears in primary lumbar spinal decompression and discectomy surgery. J Clin Neurosci. 2018; 50: 177-82.
3. Kothe R, Quante M, Engler N, et al. The effect of incidental dural lesions on outcome after decompression surgery for lumbar spinal stenosis: results of a multi-center study with 800 patients. Eur Spine J. 2017; 26 (10): 2504-11.
4. Khazim R, Dannawi Z, Spacey K, et al. Incidence and treatment of delayed symptoms of CSF leak following lumbar spinal surgery. Eur Spine J. 2015; 24 (9): 2069-76.
5. Khan MH, Rihn J, Steele G, et al. Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa, 1976), 2006; 31 (22): 2609-13.
6. Durand WM, DePasse JM, Kuris EO, Yang J, Daniels AH. Late-presenting dural tear: incidence, risk factors,
and associated complications. Spine J. 2018; 18 (11): 2043-50.
7. Menon SK, Onyia CU. A short review on a complication of lumbar spine surgery: CSF leak. Clin Neurol Neurosurg. 2015; 139: 248-51.
8. Sin AH, Caldito G, Smith D, Rashidi M, Willis B, Nanda A. Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery. J Neurosurg Spine, 2006; 5 (3): 224-7.
9. Syre P, Bohman LE, Baltuch G, Le Roux P, Welch WC. Cerebrospinal fluid leaks and their management after anterior cervical discectomy and fusion: a report of 13 cases and a review of the literature. Spine (Phila Pa, 1976), 2014; 39 (16): E936-43.
10. Takenaka S, Makino T, Sakai Y, et al. Dural tear is associated with an increased rate of other perioperative complications in primary lumbar spine surgery for degenerative diseases. Medicine (Baltimore), 2019; 98 (1): e13970.
11. Wang JC, Bohlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am. 1998; 80 (12): 1728-32.
12. Wong AP, Shih P, Smith TR, et al. Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foraminotomy, discectomy, or laminectomy. World Neurosurg. 2014; 81 (3-4): 634-40.
13. Cammisa FP, Jr., Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental durotomy in spine surgery. Spine (Phila Pa, 1976), 2000; 25 (20): 2663-7.
14. Yoshihara H, Yoneoka D. Incidental dural tear in lumbar spinal decompression and discectomy: analysis of a nationwide database. Arch Orthop Trauma Surg. 2013; 133 (11): 1501-8.
15. Papavero L, Engler N, Kothe R. Incidental durotomy in spine surgery: first aid in ten steps. Eur Spine J. 2015; 24 (9): 2077-84.
16. Bernatz JT, Anderson PA. Thirty-day readmission rates in spine surgery: systematic review and meta-analysis. Neurosurg Focus, 2015; 39 (4): E7.
17. Tsutsumimoto T, Yui M, Uehara M, Ohta H, Kosaku H, Misawa H. A prospective study of the incidence and outcomes of incidental dural tears in microendoscopic lumbar decompressive surgery. Bone Joint J. 2014; 96-b (5): 641-5.
18. Takahashi Y, Sato T, Hyodo H, et al. Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations: clinical article. J Neurosurg Spine, 2013; 18 (2): 165-9.
19. Saxler G, Kramer J, Barden B, Kurt A, Pfortner J, Bernsmann K. The long-term clinical sequelae of incidental durotomy in lumbar disc surgery. Spine (Phila Pa, 1976), 2005; 30 (20): 2298-302.
20. Brookfield K, Randolph J, Eismont F, Brown M. Delayed symptoms of cerebrospinal fluid leak following lumbar decompression. Orthopedics, 2008; 31 (8): 816.
21. Endriga DT, Dimar JR, 2nd, Carreon LY. Communicating hydrocephalus, a long-term complication of dural tear during lumbar spine surgery. Eur Spine J. 2016; 25 Suppl. 1: 157-61.
22. Cain JE, Jr., Lauerman WC, Rosenthal HG, Broom MJ, Jacobs RR. The histomorphologic sequence of dural repair. Observations in the canine model. Spine (Phila Pa, 1976), 1991; 16 (8 Suppl): S319-23.
Downloads
Published
Issue
Section
License
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
