Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management
BackgroundCerebrospinal fluid leakage (CSFL) following spinal durotomy can lead to severe sequelae. However, while several studies have investigated accidental spinal durotomies, the risk factors and influence of clinical management in planned durotomies remain unclear.MethodsWe performed a retrospe...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.959533/full |
| _version_ | 1811267019592433664 |
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| author | Moritz Lenschow Moritz Perrech Sergej Telentschak Niklas von Spreckelsen Julia Pieczewski Roland Goldbrunner Volker Neuschmelting |
| author_facet | Moritz Lenschow Moritz Perrech Sergej Telentschak Niklas von Spreckelsen Julia Pieczewski Roland Goldbrunner Volker Neuschmelting |
| author_sort | Moritz Lenschow |
| collection | DOAJ |
| description | BackgroundCerebrospinal fluid leakage (CSFL) following spinal durotomy can lead to severe sequelae. However, while several studies have investigated accidental spinal durotomies, the risk factors and influence of clinical management in planned durotomies remain unclear.MethodsWe performed a retrospective analysis of all patients who underwent planned intradural spinal surgery at our institution between 2010 and 2020. Depending on the occurrence of a CSFL, patients were dichotomized and compared with respect to patient and case-related variables as well as dural closure technique, epidural drainage placement, and timing of mobilization.ResultsA total of 351 patients were included. CSFL occurred in 4.8% of all cases. Surgical indication, tumor histology, location within the spine, previous intradural surgery, and medical comorbidities were not associated with an increased risk of CSFL development (all p > 0.1). Age [odds ratio (OR), 0.335; 95% confidence interval (CI), 0.105–1.066] and gender (OR, 0.350; 95% CI, 0.110–1.115) were not independently associated with CSFL development. There was no significant association between CSFL development and the dural closure technique (p = 0.251), timing of mobilization (p = 0.332), or placement of an epidural drainage (p = 0.321).ConclusionCSFL following planned durotomy pose a relevant and quantifiable complication risk of surgery that should be factored in during preoperative patient counseling. Our data could not demonstrate superiority of any particular dural closure technique but support the safety of both early mobilization within 24 h postoperatively and epidural drainage with reduced or no force of suction. |
| first_indexed | 2024-04-12T20:53:49Z |
| format | Article |
| id | doaj.art-b98aa00d527d434fb04a75f900cacdb7 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-12T20:53:49Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-b98aa00d527d434fb04a75f900cacdb72022-12-22T03:17:02ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-09-01910.3389/fsurg.2022.959533959533Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical managementMoritz LenschowMoritz PerrechSergej TelentschakNiklas von SpreckelsenJulia PieczewskiRoland GoldbrunnerVolker NeuschmeltingBackgroundCerebrospinal fluid leakage (CSFL) following spinal durotomy can lead to severe sequelae. However, while several studies have investigated accidental spinal durotomies, the risk factors and influence of clinical management in planned durotomies remain unclear.MethodsWe performed a retrospective analysis of all patients who underwent planned intradural spinal surgery at our institution between 2010 and 2020. Depending on the occurrence of a CSFL, patients were dichotomized and compared with respect to patient and case-related variables as well as dural closure technique, epidural drainage placement, and timing of mobilization.ResultsA total of 351 patients were included. CSFL occurred in 4.8% of all cases. Surgical indication, tumor histology, location within the spine, previous intradural surgery, and medical comorbidities were not associated with an increased risk of CSFL development (all p > 0.1). Age [odds ratio (OR), 0.335; 95% confidence interval (CI), 0.105–1.066] and gender (OR, 0.350; 95% CI, 0.110–1.115) were not independently associated with CSFL development. There was no significant association between CSFL development and the dural closure technique (p = 0.251), timing of mobilization (p = 0.332), or placement of an epidural drainage (p = 0.321).ConclusionCSFL following planned durotomy pose a relevant and quantifiable complication risk of surgery that should be factored in during preoperative patient counseling. Our data could not demonstrate superiority of any particular dural closure technique but support the safety of both early mobilization within 24 h postoperatively and epidural drainage with reduced or no force of suction.https://www.frontiersin.org/articles/10.3389/fsurg.2022.959533/fullcerebrospinal fluid leakdrainagepostoperative complicationsmobilizationspine |
| spellingShingle | Moritz Lenschow Moritz Perrech Sergej Telentschak Niklas von Spreckelsen Julia Pieczewski Roland Goldbrunner Volker Neuschmelting Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management Frontiers in Surgery cerebrospinal fluid leak drainage postoperative complications mobilization spine |
| title | Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management |
| title_full | Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management |
| title_fullStr | Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management |
| title_full_unstemmed | Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management |
| title_short | Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management |
| title_sort | cerebrospinal fluid leaks following intradural spinal surgery risk factors and clinical management |
| topic | cerebrospinal fluid leak drainage postoperative complications mobilization spine |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.959533/full |
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