Managing Cerebrospinal Fluid (CSF) Leak after Lumbar Spinal Fusion: When Conservative Treatment is not the Answer?

Introduction: CSF leaks are a known complication of lumbar fusion surgery. There is a scarcity of literature describing the management of this complication. The aim of this study was to identify patients who are at risk of requiring further intervention for managing CSF leaks.

Methods: The Nationwide Inpatient Sample (NIS) database was used to identify patients who had lumbar fusion in the United States from 2002 to 2014. Inpatient outcomes including the incidence and risk factors for requiring an intervention were calculated. Secondary outcomes including average length of stay (LOS), mean cost, and mortality rates were calculated. All statistical analyses were conducted based on multivariate regression models using the SPSS software.

Results: A total of 11,636 patients with post-operative CSF leak after elective lumbar fusion were identified in the NIS database from 2002 to 2014. Of these patients, 79.9% (9,294/11,636) required an advanced intervention including epidural blood patch, simple repair, or operative management. There was an increase of 13% per year in the use of an intervention in managing CSF leaks. After controlling for several confounding factors, independent risk factors for requiring an intervention included: older age (OR: 1.01; 95% CI: 1.005-1.013; p<0.0001), lateral approach (OR: 1.52; 95% CI: 1.26-1.81; p<0.0001) and posterior approach (OR: 1.60; 95% CI: 1.34-1.91; p<0.0001) compared to anterior approach. Nonsurgical treatment was associated with increased length of stay (5.93±4.61 vs. 5.25±3.63;p<0.0001) with similar hospitalization costs (119,537.2±89,045.6 vs. 120,277.9±87,894.1; p=0.72) and mortality (0.3% vs. 0.3%; p>0.05).

Conclusion: Spine surgeons should be aware of certain patient and procedure-specific characteristics that increase the risk of requiring an intervention for CSF leak management after lumbar fusion to improve patient outcomes.