Jiang Lei, Budu Alexandru, Khan Muhammad Shuaib, Goacher Edward, Kolias Angelos, Trivedi Rikin, Francis Jibin
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Queen Elizabeth Hospital, Birmingham, UK.
Neurospine. 2023 Sep;20(3):783-789. doi: 10.14245/ns.2346432.216. Epub 2023 Sep 30.
We aim to compare the effectiveness of dural closure techniques in preventing cerebrospinal fluid (CSF) leaks following surgery for intradural lesions and seek to identify additional factors associated with CSF leaks. Surgical management of spinal intradural lesions involves durotomy which requires a robust repair to prevent postoperative CSF leakage. The ideal method of dural closure and the efficacy of sealants has not been established in literature.
We performed a retrospective analysis of all intradural spinal cases performed at a tertiary spine centre from 1 April 2015 to 29 January 2020 and collected data on patient bio-profile, dural repair technique, and CSF leak rates. Multivariate analysis was performed to identify predictors for postoperative CSF leak.
A total of 169 cases were reported during the study period. There were 15 cases in which postoperative CSF leak was reported (8.87%). Multivariate analysis demonstrated that patient age (odds ratio [OR], 0.942; 95% confidence interval [CI], 0.891-0.996), surgical indication listed in the "others" category (OR, 44.608; 95% CI, 1.706-166.290) and dural closure with suture, sealant and patch (OR, 22.235; 95% CI, 2.578-191.798) were factors associated with CSF leak. Postoperative CSF leak was associated with the risk of surgical site infection with a likelihood ratio of 8.704 (χ² (1) = 14.633, p < 0.001).
Identifying predictors for CSF leaks can assist in the counselling of patients with regard to surgical risk and expected postoperative recovery.
我们旨在比较硬膜封闭技术在预防硬膜内病变手术后脑脊液（CSF）漏方面的有效性，并试图确定与脑脊液漏相关的其他因素。脊髓硬膜内病变的手术治疗涉及硬脊膜切开术，这需要进行可靠的修复以防止术后脑脊液漏。文献中尚未确定理想的硬膜封闭方法和密封剂的疗效。
我们对2015年4月1日至2020年1月29日在一家三级脊柱中心进行的所有硬膜内脊柱病例进行了回顾性分析，并收集了患者生物特征、硬膜修复技术和脑脊液漏率的数据。进行多变量分析以确定术后脑脊液漏的预测因素。
研究期间共报告了169例病例。有15例报告了术后脑脊液漏（8.87%）。多变量分析表明，患者年龄（比值比[OR]，0.942；95%置信区间[CI]，0.891 - 0.996）、“其他”类别中列出的手术指征（OR，44.608；95% CI，1.706 - 166.290）以及用缝线、密封剂和补片进行硬膜封闭（OR，22.235；95% CI，2.578 - 191.798）是与脑脊液漏相关的因素。术后脑脊液漏与手术部位感染风险相关，似然比为8.704（χ²(1)=14.633，p < 0.001）。
确定脑脊液漏的预测因素有助于在手术风险和术后预期恢复方面为患者提供咨询。
