gms | German Medical Science

Objective: A retrospective clinical study to assess the treatment strategies in postsurgical CSF leakage and further to explore the best period of time of keeping a drainage in situ.

Summary of background data: To date, no standard treatment principles and methods are accepted for the treatment of CSF leakage of posterior approach spinal surgery and no report is available about the optimal time of keeping a drain in case of an unrepaired dural tear inside the patient.

Method: A retrospective study to analyze the cases of CSF leakage during posterior approach spinal surgery. All cases were divided into 4 groups according to the following features: whether to repair the dura tear, whether to put in a drainage tube, and the days of drain insertion after the surgery. For Group A, the dural tear was left unrepaired, with interrupted suture of the deep and superficial fascia, and keeping a drainage tube for 3–5 days. Those cases with unrepaired dura but continuous locking suture of the deep and superficial fascia were classified as Group B if the drainage tube was left for 5–7 days and Group C if the drain was left for 8–12 days. Those cases in which no drainage tube was used but the dural tear was sutured with addition of albumin glue and continuous suture of the deep and superficial fascia, builded Group D. In Group B, the drainage tube was clamped for 24 hours before being removed so as to observe whether CSF still leaks out of the skin incision.

Results: 269 patients (112 female and 157 male) with incidental durotomy causing CSF leak during posterior approach spinal surgery were enrolled in this study. The average age was 49.7 years (ranging from 11 to 78 years). There were 72.7% patients in group A (48 of 66 cases) developing CSF leak through the skin incision and 35 cases were treated well with re-operation. Mean time for the incision healing was 17.2±3.7 days. There were 2 cases of superficial infection and 1 case of the deep infection but all recovered very well. In Group B (83 cases) and C (58 cases ), none was found with the CSF leak through the wound and mean time for the incision healing was 10.4±2.5 days and 10.8±2.6 days respectively. For Group D, there were 30.6% of patients (19 of 62 patients) with CSF leakage through the wound and 17 cases of them were re-operated after failure of conservative measures. No cases of infection were found in group D. The differences of wound healing time between group A and group B and C were statistically significant.

Conclusions: The core of managing CSF leakage after posterior approach spinal surgery is avoiding flow of CSF through wound. The most critical step is strictly suturing both deep and superficial fascia and keeping the drainage tube for at least 5 days.