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Kim JY, Oh BH, Kim IS, Hong JT, Sung JH, Lee HJ. The safety and effectiveness of lumbar drainage for cerebrospinal fluid leakage after spinal surgery. Neurochirurgie 2023; 69:101501. [PMID: 37741364 DOI: 10.1016/j.neuchi.2023.101501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE Cerebrospinal fluid (CSF) leakage is a frequent complication after spinal surgery. The lumbar drainage procedure (LDP) is the preferred method for early closure of a dural tear. This study was conducted to assess the safety and effectiveness of LDP after spinal surgery. MATERIALS AND METHODS We retrospectively reviewed 122 patients (55 male and 67 female) who underwent LDP after spinal surgery between January 2010 and June 2021. LDP was performed on patients with suspected CSF leakage due to a dural tear during spinal surgery or in whom mixed-color CSF was observed in the hemo-drain after surgery. LDP was performed aseptically by a resident according to our institution's protocol, and the amount drained was from 200cc to 300cc per day. Absolute bed rest was maintained during the lumbar drainage period. The hemo-drain was opened to confirm that CSF was no longer mixed or oozing, at which time the lumbar drain was removed. Culture was performed at the drain tip when the lumbar drain was removed. RESULTS The spinal surgery level was cervical in 23 patients, thoracic in 27 patients, and lumbar in 72 patients. The mean duration of the indwelling lumbar drain was 7.2 days (2 days-18 days), and the mean amount of drainage was 1198.2cc (100cc-2542cc). Among the 122 patients, the CSF leakage in 101 patients was resolved with the initial procedure, but 21 patients required re-insertion. Of those 21 patients, improper insertion due to a technical problem occurred in 15 patients, poor line fixation occurred in 2 patients, and CSF leakage was again observed after removal of the lumbar drain in 4 patients. In only 1 case was open surgery done after LDP because follow-up magnetic resonance imaging showed a suspected infection. During lumbar drainage, 76 patients used antibiotics, and 46 patients did not. Four patients showed bacterial growth in the tip culture, and 3 of them had been using antibiotics. All 4 of those patients were treated without complications and discharged. Among the 122 patients, 1 patient was discharged with left hemiparesis due to cerebral venous infarction (CVI) and hemorrhage after LDP, and 1 patient underwent re-operation because the CSF collection was not resolved. CONCLUSIONS No major complications such as systemic infection, deep vein thrombosis, or aspiration pneumonia occurred during the lumbar drainage, except for 1 patient (0.8%) with CVI caused by over-drainage. One patient (0.8%) required open surgery after LDP, but no cases of systemic infection occurred while maintaining lumbar drainage, irrespective of antibiotic use. In conclusion, LDP is a safe and effective treatment for CSF leakage after spinal surgery.
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Affiliation(s)
- Jee Yong Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Byeong Ho Oh
- Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Cheongju, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea.
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Jin JY, Yu M, Xu RF, Sun Y, Li BH, Zhou FF. Risk Factors for Cerebrospinal Fluid Leakage After Extradural Spine Surgery: A Meta-Analysis and Systematic Review. World Neurosurg 2023; 179:e269-e280. [PMID: 37625633 DOI: 10.1016/j.wneu.2023.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage is 1 of the common complications of spine surgery and is largely caused by intraoperative or postoperative dural tears. Associations of different factors with postoperative CSF leakage have not been consistent. In this study we aimed to identify demographic, disease-related, and surgical risk factors for CSF leakage after extradural spine surgery in a systematic review and meta-anlysis. METHODS The PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Wanfang data, Chinese Weipu Database, and SinoMed databases were searched from inception until October 24, 2022. Fixed-effects or random-effects models were used to calculate odds ratios and 95% confidence intervals. The quality of observational studies was evaluated using the Newcastle-Ottawa scale instrument. RESULTS A total of 15 observational studies with 1,719,923 participants were included in this systematic review. All studies had a Newcastle-Ottawa scale score greater than or equal to 6. Age older than 70 years, smoking, ossification of the posterior longitudinal ligament, adhesion of spinal dura, spinal canal stenosis, cervical fracture, spondylolisthesis, revision surgery, and multiple surgical segments were all related to CSF leakage in the pooled analysis. Obesity and disease duration>1 year were not associated with the leakage of CSF. CONCLUSIONS This study will provide a reference for the identification of patients at high risk of developing CSF leakage, which suggests clinicians to strengthen the observation of drainage fluid in high-risk groups.
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Affiliation(s)
- Ji-Yan Jin
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China
| | - Miao Yu
- Department of Nursing, Peking University Third Hospital, Beijing, PR China
| | - Rui-Feng Xu
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China
| | - Yu Sun
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China
| | - Bao-Hua Li
- Department of Neurology, Peking University Third Hospital, Beijing, PR China
| | - Fei-Fei Zhou
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China.
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Nielsen TH, Rasmussen MM, Thygesen MM. Incidence and risk factors for incidental durotomy in spine surgery for lumbar stenosis and herniated disc. Acta Neurochir (Wien) 2022; 164:1883-1888. [PMID: 35641649 DOI: 10.1007/s00701-022-05259-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Incidental durotomy (ID) is one of the most common complications in degenerative surgery. Due to the negative consequences of ID, knowledge about incidence and risk factors is warranted. METHODS A total of 1,139 surgical procedures for lumbar spinal stenosis (LS) and lumbar herniated disc (LDH) were included from the spine surgery database: DaneSpine. Uni- and multivariate analyses were performed for the assessment of possible risk factors. RESULTS ID occurred in 10.4% of the surgical procedures. A multivariate regression analysis revealed an increased relative risk of ID by 2% per year of age, 58% by revision surgery, and 55% by decompression on multiple levels. CONCLUSION In our single-centre cohort study, one in ten patients experiences an ID. Increasing age, revision surgery and decompression of multiple levels are risk factors of ID in degenerative surgery of the lumbar spine.
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Affiliation(s)
- Teresa Haugaard Nielsen
- Cense Spine, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | | | - Mathias Møller Thygesen
- Cense Spine, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Alshameeri ZAF, Jasani V. Risk Factors for Accidental Dural Tears in Spinal Surgery. Int J Spine Surg 2021; 15:536-548. [PMID: 33986000 DOI: 10.14444/8082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Accidental dural tears (DTs) are familiar complications of spinal surgery. Their reported incidence varies widely, and several risk factors have been proposed in the literature. The aim of this study was to conduct a systematic review and meta-analysis to determine the rate of DTs and assess their associated risk factors. METHODS A systematic literature search was conducted using specific MeSH and Text terms. Only articles with prospective data reporting the incidence and risk factors were selected and reviewed based on specific inclusion and exclusion criteria. RESULTS Twenty-three studies were included. The reported incidence rate ranged from 0.4% to 15.8%, giving an overall pooled incidence rate of 5.8% (95% confidence interval [CI] 4.4-7.3). The incidence rate varied in relation to the part of the spine and the type of surgery. Three factors were associated with a high rate of DTs: age (overall mean difference of 3.04, 95% CI 2.49-3.60), revision surgery (overall odds ratio of 2.28, 95% CI 1.84-2.83), and lumbar stenosis (overall odds ratio of 2.03, 95% CI 1.50-2.75). Diabetes was weakly associated with DTs, with an odds ratio of 1.40 (95% CI 1.01-1.93). The overall effects of sex and obesity were not statistically significant. CONCLUSION Advancing age, revision surgery, and lumbar stenosis were significantly associated with increased risk of DTs. These factors should be taken into consideration during the consenting process for spinal surgery. CLINICAL RELEVANCE Risk of dural tear during spine surgery.
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Affiliation(s)
- Zeiad A F Alshameeri
- University Hospital of North Midlands, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Vinay Jasani
- University Hospital of North Midlands, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
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Murphy ME, Kerezoudis P, Alvi MA, McCutcheon BA, Maloney PR, Rinaldo L, Shepherd D, Ubl DS, Krauss WE, Habermann EB, Bydon M. Risk factors for dural tears: a study of elective spine surgery . Neurol Res 2016; 39:97-106. [PMID: 27908218 DOI: 10.1080/01616412.2016.1261236] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study moves beyond previous cohort studies and benchmark data by studying a population of elective spine surgery from a multicenter registry in an effort to validate, disprove, and/or identify novel risk factors for dural tears. METHODS A retrospective cohort analysis queried a multicenter registry for patients with degenerative spinal diagnoses undergoing elective spinal surgery from 2010-2014. Multivariable logistic regression analysis interrogated for independent risk factors of dural tears. RESULTS Of 104,930 patients, a dural tear requiring repair occurred in 0.6% of cases. On adjusted analysis, the following factors were independently associated with increased likelihood of a dural tear: ankylosing spondylitis vs. intervertebral disc disorders, greater than two levels, combined surgical approach and posterior approach vs. anterior approach, decompression only vs. fusion and decompression, age groups 85+, 75-84 and 65-74 vs. <65, obesity (BMI ≥30), corticosteroid use and preoperative platelet count <150,000. CONCLUSIONS This multicenter study identifies novel risk factors for dural tears in the elective spine surgery population, including corticosteroids, thrombocytopenia, and ankylosing spondylitis. The results of this analysis provide further information for surgeons to use both in operative planning and in preoperative counseling when discussing the risk of dural tears.
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Affiliation(s)
- Meghan E Murphy
- a Department of Neurologic Surgery , Mayo Clinic , Rochester , MA , USA.,b Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MA , USA
| | - Panagiotis Kerezoudis
- a Department of Neurologic Surgery , Mayo Clinic , Rochester , MA , USA.,b Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MA , USA
| | - Mohammed Ali Alvi
- a Department of Neurologic Surgery , Mayo Clinic , Rochester , MA , USA.,b Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MA , USA
| | - Brandon A McCutcheon
- a Department of Neurologic Surgery , Mayo Clinic , Rochester , MA , USA.,b Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MA , USA
| | - Patrick R Maloney
- a Department of Neurologic Surgery , Mayo Clinic , Rochester , MA , USA.,b Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MA , USA
| | - Lorenzo Rinaldo
- a Department of Neurologic Surgery , Mayo Clinic , Rochester , MA , USA.,b Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MA , USA
| | - Daniel Shepherd
- a Department of Neurologic Surgery , Mayo Clinic , Rochester , MA , USA.,b Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MA , USA
| | - Daniel S Ubl
- c Department of Health Sciences Research , Mayo Clinic , Rochester , MA , USA
| | - William E Krauss
- a Department of Neurologic Surgery , Mayo Clinic , Rochester , MA , USA
| | | | - Mohamad Bydon
- a Department of Neurologic Surgery , Mayo Clinic , Rochester , MA , USA.,b Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MA , USA.,d Health Services Research and Neurosurgery and Orthopedics , College of Medicine, Mayo Clinic , Rochester , MA , USA
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