Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery

OBJECTIVE: To analyze the risk factors of cerebrospinal fluid leakage (CSFL) following lumbar posterior surgery and summarize the related management strategies. METHODS: A retrospective analysis was performed on 3179 patients with CSFL strategies lumbar posterior surgery in our hospital from January 2019 to December 2020. There were 807 cases of lumbar disc hemiation (LDH), 1143 cases of lumbar spinal stenosi (LSS), 1122 cases of lumbar spondylolisthesis(LS), 93 cases of lumbar degenerative scoliosis(LDS),14 cases of lumbar spinal benign tumor (LST). Data of gender, age, body mass index(BMI), duration of disease, diabete, smoking history, preoperative epidural steroid injection, number of surgical levels, surgical methods (total laminar decompression, fenestration decompression), revision surgery, drainage tube removal time, suture removal time, and complications were recorded. RESULTS: The incidence of 115 cases with cerebrospinal fluid leakage, was 3.6% (115/3179).One-way ANOVA showed that gender, body mass index (BMI), smoking history, combined with type 2 diabetes and surgical method had no significant effect on CSFL (P > 0.05). Age, type of disease, duration of disease, preoperative epidural steroid injection, number of surgical levels and revision surgery had effects on CSFL (P < 0.05). Multivariate Logistic regression analysis showed that type of disease, preoperative epidural steroid injection, number of surgical levels and revision surgery were significantly affected CSFL (P < 0.05).Drainage tube removal time of CSFL patients ranged from 7 to 11 days, with an average of 7.1 ± 0.5 days, drainage tube removal time of patients without CSFL was 1–3 days, with an average of 2.0 ± 0.1 days, and there was a statistical difference between the two groups (P < 0.05).The removal time of CSFL patients was 12–14 days, with an average of 13.1 ± 2.7 days, and the removal time of patients without CSFL was 10–14 days, with an average of 12.9 ± 2.2 days, there was no statistically significant difference between the two groups (P > 0.05). CONCLUSION: Type of disease, preoperative epidural steroid injection, number of surgical levels and revision surgery were the risk factors for CSFL. Effective prevention were the key to CSFL in lumbar surgery. Once appear, CSFL can also be effectively dealt without obvious adverse reactions after intraoperative effectively repair dural, head down, adequate drainage after operation, the high position, rehydration treatment, and other treatments.