Risk Factors for Persistent Cerebrospinal Fluid Leakage in Lumbar Spinal Surgery: A Retrospective Analysis of 323
David Ephraim Bauer1, Christoph Johannes Laux, Method Kabelitz
1University Spine Center, Balgrist University Hospital, Zurich, Switzerland.
Study Design:
Retrospective cohort study.
Objective:
To identify risk factors for revision surgery due to persistent cerebrospinal fluid (CSF) leakage after an intraoperatively recognized and repaired incidental durotomy (ID) in lumbar spine surgery.
Background:
ID is a common complication in spine surgery, often leading to CSF leakage, prolonged hospitalization, and increased morbidity. While risk factors for ID are well described, limited data exist on predictors of persistent CSF leakage requiring revision surgery.
Materials And Methods:
A total of 323 patients who sustained an intraoperatively recognized and repaired ID during lumbar spine surgery were retrospectively analyzed. Patients with traumatic dural tears or bacterial infections were excluded. Demographic data, comorbidities, surgical details, and complications were recorded. Univariate and multivariate logistic regression analyses identified independent risk factors for revision surgery.
Results:
Fifteen patients (4.64%) required revision surgery for persistent CSF leakage. Univariate analysis identified type 2 diabetes, chronic obstructive pulmonary disease, chronic kidney disease, and metastatic tumor history as risk factors. Multivariate analysis confirmed type 2 diabetes (aOR: 3.732; 95% CI: 1.093-12.739; P = 0.036), metastatic tumor history (aOR: 15.758; 95% CI: 2.339-106.160; P = 0.005), and male sex (aOR: 4.018; 95% CI: 1.022-15.794; P = 0.046) as independent risk factors. Revision patients had significantly longer hospital stays (16 vs. 8 d, P = 0.014) and higher rates of wound infection and ischemic stroke.
Conclusions:
Type 2 diabetes, metastatic tumor history, and male sex are independent risk factors for revision surgery due to persistent CSF leakage after ID repair. These findings highlight the need for increased vigilance and potentially modified dural repair strategies in high-risk patients.
