Cerebrospinal fluid leaks following intradural spinal surgery-Risk factors and clinical management.
cerebrospinal fluid leak
drainage
mobilization
postoperative complications
spine
Journal
Frontiers in surgery
ISSN: 2296-875X
Titre abrégé: Front Surg
Pays: Switzerland
ID NLM: 101645127
Informations de publication
Date de publication:
2022
2022
Historique:
received:
01
06
2022
accepted:
29
08
2022
entrez:
7
10
2022
pubmed:
8
10
2022
medline:
8
10
2022
Statut:
epublish
Résumé
Cerebrospinal 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. We 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. A 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 CSFL 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.
Sections du résumé
Background
UNASSIGNED
Cerebrospinal 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.
Methods
UNASSIGNED
We 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.
Results
UNASSIGNED
A 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
Conclusion
UNASSIGNED
CSFL 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.
Identifiants
pubmed: 36204341
doi: 10.3389/fsurg.2022.959533
pmc: PMC9530256
doi:
Types de publication
Journal Article
Langues
eng
Pagination
959533Informations de copyright
© 2022 Lenschow, Perrech, Telentschak, Von Spreckelsen, Pieczewski, Goldbrunner and Neuschmelting.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
Medicine (Baltimore). 2019 Jan;98(1):e13970
pubmed: 30608436
J Neurol Surg A Cent Eur Neurosurg. 2013 Jul;74(4):216-21
pubmed: 22855319
J Am Acad Orthop Surg. 2021 Mar 15;29(6):e279-e286
pubmed: 33539059
Spine (Phila Pa 1976). 1999 Oct 1;24(19):2062-4
pubmed: 10528385
Eur Spine J. 2020 Jan;29(1):141-146
pubmed: 31552537
Eur Spine J. 2009 Aug;18(8):1169-74
pubmed: 19283413
World Neurosurg. 2018 Dec;120:e497-e502
pubmed: 30149160
Eur Spine J. 2013 Mar;22(3):577-83
pubmed: 23001449
Neurosurg Focus. 2015 Aug;39(2):E11
pubmed: 26235009
World Neurosurg. 2019 Jul;127:567-575.e1
pubmed: 30928579
J Clin Neurosci. 2017 Apr;38:32-36
pubmed: 28089196
Spine (Phila Pa 1976). 2020 Dec 1;45(23):E1615-E1621
pubmed: 32833929
Korean J Spine. 2016 Mar;13(1):24-9
pubmed: 27123027
Br J Neurosurg. 2013 Dec;27(6):800-2
pubmed: 23724795
World Neurosurg. 2014 Mar-Apr;81(3-4):634-40
pubmed: 24239738
J Clin Neurosci. 2019 Mar;61:88-92
pubmed: 30414810
J Neurosurg Spine. 2017 Jan;26(1):103-111
pubmed: 27472744
J Neurosurg Spine. 2014 Aug;21(2):279-85
pubmed: 24867211
Spine (Phila Pa 1976). 2006 Oct 15;31(22):2609-13
pubmed: 17047553
Global Spine J. 2016 Dec;6(8):780-785
pubmed: 27853662
Surg Neurol. 2006 Apr;65(4):410-4, discussion 414-5
pubmed: 16531215
Spine J. 2017 Sep;17(9):1335-1341
pubmed: 28412565
Acta Neurochir (Wien). 2014 Sep;156(9):1813-20
pubmed: 25047813
Chin J Traumatol. 2016;19(1):35-8
pubmed: 27033271
World Neurosurg. 2012 Sep-Oct;78(3-4):344-7
pubmed: 22381274
Eur Spine J. 2015 Sep;24(9):2065-8
pubmed: 25099874