Therapeutic Results of CSF Leakage due to Unintended Incidental Durotomy in Spine Surgery

ABSTRACT

OBJECTIVE: This study is designed to analyse the result of cerebrospinal fluid(CSF) leakage due to unintended incidental durotomy in spine surgery and to determine the timing of repair operation for CSF leakage. METHODS: Iatrogenic dura tearing occurred in 114 cases among the 1626 spine operation patients. This study included 29 consecutive patients with postoperative CSF leakage at the operative wound who did not underwent intraoperative dural closure. RESULTS: Of the 29 patients in this study, 24% had clinical symptom after CSF leakage. Four patients reported headache, three reported aggravation of lumbago. Reoperation for dura or wound repair were performed in 12 cases. Incidence of reoperation was higher in patients who underwent total laminectomy including resection of spinous process than in those who underwent partial hemilaminectomy. The CSF obtained at the reoperation was cultured. Staphylococcus aureus were cultured in 5 patients and not in 7 patients. The mean period between reoperation and the first CSF wound leakage was longer in culture positive group(14.8days) than in culture negative group(6.6days). The period between reoperation and the first CSF leakage in all of the culture positive patients was longer than 10 days. CONCLUSION: In case that CSF wound leakage in total laminectomy patients persist longer than 10days in spite of conservative management, we recommend to perform dura/wound repair without delay.