gms | German Medical Science

Objective: While several studies have investigated the incidence and perioperative management in accidental spinal durotomies, the impact of postoperative bed rest or epidural drainage on the incidence of cerebrospinal fluid leakage (CSFL) in planned durotomies is unclear. This study aimed to assess the impact of the perioperative management on the incidence of CSFL in planned durotomies.

Methods: All planned intradural spine surgeries performed at our institution between 2010 and 2020 were retrospectively reviewed and all cases that underwent the standard dural closure technique at our institution (primary suture topped by patch sealant) were included in the study. CSFL was defined as leakage through the wound or development of a pseudomeningocele necessitating operative treatment and patients were dichotomized accordingly. The incidence of CSFL was analyzed with regard to timing of mobilization, defined as “early” (within 24h) or “late” (minimum 24h bed rest), as well as with regard to the possible impact of epidural drainage placement.

Results: 256 cases were included in the study. The median patient age was 55 years, 50.4 % were female. The overall incidence of CSFL was found to be 4.3% (11 cases). Patient- or procedure-related factors did not significantly differ between the early and late mobilization group or between the drainage and no-drainage group (all p > 0.1). Patients were mobilized within 24h postoperatively in 129 (50.4%) of cases, the frequency of revision surgery for CSFL was not significantly different between the early (4/129, 3.1%) and late (7/127, 5.5%) mobilization group (p = 0.374). In cases of epidural drainage placement (143/256, 55.9%), the incidence of CSFL was 4/143 (2.8%) cases compared to 7/113 (6.2%) cases that did not receive an epidural drainage (p = 0.222). Force of suction was not found to impact CSFL development (reduced suction 2/75 (2.7%) vs 2/68 (2.9%) no suction; p = 0.921) either.

Conclusion: Our retrospective analysis demonstrated an incidence of CSFL of about 4% following intradural surgery and standard dural closure by suture and patch sealant. Early mobilization as well as epidural drainage with at least reduced suction force were found to be safely applicable and favorable with regard to prevent non-CSFL related complications following planned spinal durotomies.