gms | German Medical Science

Cerebrospinal fluid leaks are a common complication in spinal surgery, caused mostly by incidental durotomy (ID), which may even remain undetected throughout surgery. Orthostatic headache, vomiting, nausea, hygroma, fistula formation and meningitis are only some of the potential sequelae. Revision procedures, spinal canal stenosis, synovial cysts and adhesions are associated with a higher risk of CSF leakage.

Several studies have been performed in the past evaluating the management of ID. Different treatment strategies have been described in the literature ranging from bedrest only to intraoperative suture or even complex reconstructive procedures.

Objective: The aim of this study was to evaluate a potential benefit of post-operative bedrest.

Methods: One hundred and fifty-four spinal surgeries with ID performed from 01/2014 to 05/2018 were retrospectively reviewed and analyzed. Of these, 139 (90%) were immediately noted during surgery and subsequently repaired with suture, fibrin-coated fleece, fibrin glue, a muscle patch or a combination thereof. A valsalva maneuver was generally performed to ensure watertight sealing before wound closure. In 15 patients (10%), the initial ID was occult and patients presented postoperatively with orthostatic headache or fistula formation. Several risk factors such as type of surgery, degree of laceration, intraoperatively chosen strategy, post-operative management (e.g. bedrest) and surgery-related complications were analyzed. The failure of postoperative bedrest was defined as necessity of revision surgery.

Results: One hundred and thirty-nine patients with intraoperatively detected incidental durotomy were included. Of these, 87 (62.6%) were additionally treated with bedrest and 52 patients were mobilized immediately after surgery. There was no significant difference in the rate of persistent CSF leakage between the patients treated with additional bedrest (N=10, 11.5%) and the patients with immediate mobilization after surgery (N=8, 15.4%) (P=0.60). The length of postoperative bedrest also had no impact on outcome (P=0.68). Importantly, there was a significantly longer hospital stay of patients who were subjected to additional bedrest (P=0.018).

Conclusion: Postoperative CSF-leakage represents a serious postoperative complication of lumbar surgery. Intraoperative dural repair is thought to play a crucial role to avoid further neurological morbidity. Postoperative bedrest does not seem to be beneficial.