Predictors of Postoperative Incisional Cerebrospinal Fluid Leak of Closed Spinal Dysraphism in Different Age Groups

Area of Science:

• Neurosurgery
• Pediatric Surgery
• Spinal Surgery

Background:

• Closed spinal dysraphism (SD) is a congenital condition requiring surgical intervention.
• Postoperative incisional cerebrospinal fluid (CSF) leaks are a significant complication following SD surgery.
• Understanding age-specific risk factors for CSF leaks is crucial for optimizing surgical care.

Purpose of the Study:

• To compare incisional CSF leak rates in different age groups undergoing closed SD surgery.
• To identify significant predictors of postoperative incisional CSF leaks across various age demographics.

Main Methods:

• Retrospective cohort study of 1226 patients who underwent closed SD surgery (January 2017 - December 2022).
• Patients categorized into four age groups: preschool children, school children, adolescents, and adults.
• Statistical analysis using Pearson's chi-squared test, Fisher's exact test, and logistic regression to evaluate 18 potential predictors.

Main Results:

• Significant differences in incisional CSF leak rates were observed across the four age groups (P < 0.001).
• Predictors varied by age: dural substitute use and surgical site infection in preschool children; scoliosis/kyphosis in adolescents; wound infection in adults.
• Synthetic bone substitute use showed a protective effect in school children (OR = 0.160, P = 0.049).

Conclusions:

• Age-specific factors significantly influence the rates and predictors of postoperative incisional CSF leaks in closed SD.
• Tailoring management strategies based on age-related risk factors can help reduce CSF leak incidence.
• Addressing these predictors is essential for improving surgical outcomes in patients with closed SD.