Risk Factors for Cerebrospinal Fluid Leak Following Anterior Cervical Discectomy and Fusion

Abstract

Study Design/Setting: This was a retrospective cohort study. Purpose: The purpose of this study was to examine the association between postoperative cerebrospinal fluid (CSF) leak and anterior cervical discectomy and fusion (ACDF). Specifically, we evaluated: (1) demographic risk factors; (2) comorbid risk factors; (3) indications for surgery; and (4) lengths of stay. Summary of Background Data: CSF leak is a rare but serious complication of ACDF. Currently, there is a paucity of literature describing the risk factors for CSF leak following ACDF. Methods: The Nationwide Inpatient Sample was used to identify all patients who underwent cervical fusion using the anterior approach with excision of intervertebral disc between 1998 and 2010. Patients who had a diagnosis of ossification of the posterior longitudinal ligament in the cervical region were excluded. All patients who had a CSF leak were identified. Demographics and comorbidities were compared via χ2 analysis, and logistic regression to calculate the odds of having a CSF leak. Results: Of the 1,261,140 patients identified, 3048 patients (0.24%) had a postoperative CSF leak. Patients who were between the ages of 55 and 69 years (P=0.038) and 70 years or older (P=0.001) were at an increased risk of CSF leak compared with patients who were aged 40–54 years. Non-white race (P=0.021), obesity, (P<0.001) and hypertension (P=0.025) were associated with an increased risk of CSF leak, but diabetes (P=0.966) and hyperlipidemia (P=0.226) were not. Herniated disc diagnosis was associated with decreased risk of CSF leak (P=0.032), but cervical spondylosis with myelopathy patients had an increased risk (P<0.001). Patients with CSF leak had a mean length of stay of 6.0 days compared with 2.1 days among controls. Conclusions: Surgical candidates who are older and non-white should be counseled of their increased risk for CSF leak in preoperative planning. Patients who are obese and have hypertension may benefit from medical optimization before surgery. Level of Evidence: Level III.

Risk Factors and Predictive Models for Early Cerebrospinal Fluid Leak after Anterior Surgery for Degenerative Cervical Myelopathy

“…The higher incidence in this study may be because the patients included in this study had cervical myelopathy, all of whom presented with symptoms of spinal cord compression, and their dura mater was naturally involved. Previous clinical investigations have also shown that patients diagnosed with cervical myelopathy have a higher incidence of postoperative CSF leak than other types, in accord with our results 14,15 . In addition, due to the popularity of techniques and referral limitations, most patients who visited our hospital for cervical surgery were in severe condition, which is probably another reason.…”

“…It has been previously reported that the risk factors for CSFL after anterior cervical surgery include age, sex, BMI, revision surgery, history of hypertension, OPLL, spinal stenosis, surgery levels, and intraoperative blood loss [15][16][17][18][19][20][21] . However, the conclusions are also very different in different studies, which may be related to the discrepancy between the included samples.…”

“…With increasing of age, dural degeneration makes its thickness thinner, and traction resistance decreases, so dural tears are more likely to occur 22 . The regression model of Kapadia et al 15 showed that the risk of CSF leak was 1.25 times higher in the age group of 55-69 years age group than in the 40-54 years age group (P = 0.038, 95% CI: 1.01, 1.55), while the risk increased to 1.64 in the age group above 70 years age group (P = 0.001, 95% CI: 1.22, 2.20). Ehresman et al 16 showed that the risk of ID/IDT increased by an average of 0.03 (P < 0.001, 95% CI: 1.012, 1.048) for per year of age.…”

Island sternocleidomastoid myocutaneous flap for posterior pharyngeal wall defect repair after anterior cervical spine surgery

“…Hannallah et al 14 focused on cervical spine dural tears, noting a 1% incidence among 2216 procedures. Although the overall incidence of durotomy is generally lower in cervical spine procedures, primary repair is often much more difficult given the limited exposure 15 . Our study revealed that the ISMF is useful as a reinforcement in the repair of persistent cervical durotomy after surgery with the ACR approach.…”

Bone Wax Occlusion: A Simple Method for managing Cerebrospinal Fluid Leakage during Anterior Cervical Discectomy and Fusion Surgery

“…CSF Leakage can cause such problems as headache, cervical mass, dysphagia, nerve damage, meningocele, or sinus formation, incision nonunion, arachnoiditis, and spinal infection [1][2][3][4][5], thereby increasing hospital stay and costs [6]. Some literatures have reported that the incidence of CSF Leakage is 0.05% -6.3% [7][8][9][10][11][12]. At present, the management measures for CSF leakage during ACDF surgery mainly include direct suture, dural patch and glue repair, lumbar drainage, observation and so forth alone or in combined application [13][14][15].…”