Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
World Neurosurg. 2022 Aug;164:e1190-e1199. doi: 10.1016/j.wneu.2022.05.129. Epub 2022 Jun 1.
Well-defined risk factors for cerebrospinal fluid leakage (CSFL) after intradural spine surgery are scarce in the literature. The aim of the present study was to identify patient- and surgery-related risk factors and the incidence of CSFL.
For the present retrospective cohort study, we identified consecutive patients who had undergone intradural spine surgery between 2009 and 2021 at our department. The primary endpoint was the incidence of clinically or radiologically proven CSFL. The effects of the clinical and surgical factors on the occurrence of CSFL were analyzed.
A total of 375 patients (60.3% women; mean age, 54 ± 16.5 years) were included. Of the 375 patients, 30 (8%) had experienced postoperative CSFL and, thus, a significantly greater risk of wound healing disorders (odds ratio [OR], 24.9; 95% confidence interval [CI], 9.3-66.7) and surgical site infections (OR, 8.4; 95% CI, 2.6-27.7; P < 0.01 for each). No patient-related factors were associated with the development of CSFL. Previous surgery at the index level correlated significantly with the occurrence of postoperative CSFL (OR, 2.76; 95% CI, 1.1-6.8; P = 0.03) on multivariate analysis. Furthermore, patients with intradural tumors tended to have a greater risk of CSFL (OR, 2.3; 95% CI, 0.9-5.8; P = 0.07). Surgery-related factors did not influence the occurrence of CSFL. Surgery on the thoracic spine had resulted in a significantly lower postoperative CSFL rate compared with surgery on the cervical or lumbar spine (OR, -2.5; 95% CI, 1.3-4.9; P = 0.02).
Our study found no modifiable risk factors for preventing CSFL after intradural spine surgery. Patients with previous surgery at the index level had a greater risk of CSFL. The occurrence of CSFL resulted in significantly more wound healing disorders and surgical site infections, necessitating further therapy.
硬脊膜内脊柱手术后脑脊液漏（CSFL）的明确危险因素在文献中很少见。本研究的目的是确定与患者和手术相关的危险因素以及 CSFL 的发生率。
本回顾性队列研究纳入了 2009 年至 2021 年在我院行硬脊膜内脊柱手术的连续患者。主要终点是临床或影像学证实的 CSFL 的发生率。分析了临床和手术因素对 CSFL 发生的影响。
共纳入 375 例患者（60.3%为女性；平均年龄 54±16.5 岁）。375 例患者中，30 例（8%）术后发生 CSFL，因此伤口愈合障碍（优势比[OR]，24.9；95%置信区间[CI]，9.3-66.7）和手术部位感染（OR，8.4；95%CI，2.6-27.7；P<0.01）的风险显著增加。无患者相关因素与 CSFL 的发生有关。指数水平的先前手术与术后 CSFL 的发生显著相关（多变量分析 OR，2.76；95%CI，1.1-6.8；P=0.03）。此外，硬脊膜内肿瘤患者发生 CSFL 的风险较高（OR，2.3；95%CI，0.9-5.8；P=0.07）。手术相关因素不影响 CSFL 的发生。与颈椎或腰椎手术相比，胸椎手术术后 CSFL 发生率显著降低（OR，-2.5；95%CI，1.3-4.9；P=0.02）。
本研究未发现硬脊膜内脊柱手术后预防 CSFL 的可改变危险因素。指数水平有先前手术的患者 CSFL 风险更大。CSFL 的发生导致明显更多的伤口愈合障碍和手术部位感染，需要进一步治疗。
