Artikel
Risk factors for postoperative spinal cerebrospinal fluid leakage after intradural spinal surgery
Risikofaktoren für postoperative spinale Liquorfisteln nach intraduraler spinaler Chirurgie
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Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Cerebrospinal fluid leakage (CSFL) is a common complication after intradural spinal surgery. There is a lack of data in the literature concerning risk factors and management. The aim of this study was to identify patient and surgery related risk factors for the occurrence of CSFL after intradural spine surgery.
Methods: For this retrospective cohort study, we identified patients who underwent intradural spinal surgery between 2009 and 2021 at our department, Primary endpoint was the incidence of clinically or radiologically proven CSFL. Clinical and surgical data were collected and the impact of patient related and perioperative factors on occurrence of CSFL was analyzed using Chi-square test and logistic regression.
Results: In total 375 patients (60.3% female, mean age 54 ± 16.5 years) were included for the final analysis. Arterial hypertension was the most frequent comorbidity affecting 26.9% of patients. Patients underwent surgery either for intradural spinal tumors (64.8%), spontaneous intracranial hypotension (25.3%), vascular pathologies (6.9%) or for spinal cord herniation (2.9%). Overall, 8% (30/375) of patients suffered postoperative CSFL. Patients with CSFL were at significant higher risk for wound healing disorders (36.7%, 11/30), surgical site infections (20%, 6/30) and need for re-surgery (96.7%, 29/30; p < 0.001 for each) comparing to those without CSFL.
Surgery at the thoracic spine had a significantly lower postoperative CSFL rate compared to surgeries at the cervical or lumbar spine (p 0.019). Previous surgery at the index level and intradural spinal tumors had the highest risk profile for CSFL (p = 0.05 and p = 0.069). No patient related factor as sex, age, BMI, smoking, diabetes or arterial hypertension had an impact on CSFL. Surgery related factors such as number of vertebral levels and duration of surgery, approach and use of sealant, also did also not influence the occurrence of CSFL. Prolonged bedrest after surgery had no impact on occurrence of CSFL.
Conclusion: Our study did not find any modifyable risk factor for preventing a CSFL after intradural spinal surgery. Patients operated for an intradural tumor or those with previous spinal surgery at the index level might be at higher risk for CSFL. As a CSFL results in significant more wound healing disorders, SSIs and further need of therapy, surveillance of these patients is crucial.