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Cerebrospinal fluid (CSF) leak after elective lumbar spinal fusion: Who is at risk?

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Abstract

Purpose

CSF leaks are a known complication of lumbar fusion surgery. There is a scarcity of literature describing the incidence and risk factors associated with this complication. The aim of this study was to identify patients who are at risk of developing postoperative CSF leak.

Methods

The Nationwide Inpatient Sample database was used to identify patients who had lumbar fusion in the US from 2002 to 2014. Inpatient outcomes included the incidence and risk of developing CSF leak based on selected patient-specific characteristics. Secondary outcomes included average length of stay, mean costs, and mortality rates. All statistical analyses were conducted based on multivariate regression models using the SPSS software.

Results

A total of 439,220 patients who underwent elective lumbar fusion procedures were identified. Of these patients, 2.6% (11,636 /439,220) were found to have CSF leak. Independent important risk factors for CSF leak development included: older age (OR: 1.025; 95% CI: 1.02–1.03; p < 0.0001), posterior approach (OR: 1.71; 95% CI: 1.59–1.85; p < 0.0001) compared to anterior approach, chronic deficiency anemia (OR: 1.21; 95% CI:1.14–1.30; p < 0.0001), obesity (OR: 1.22; 95% CI: 1.15–1.30; p < 0.0001), and pulmonary circulatory disease (OR: 1.44; 95% CI: 1.18–1.75; p < 0.0001). CSF leak was associated with increased length of stay (5.39 ± 3.86 vs. 3.74 ± 2.55; p < 0.0001), hospitalization costs (120,129.0 ± 88,123.5 vs. 89,226.8 ± 65,350.3; p < 0.0001) and mortality (0.3% vs. 0.1%; p < 0.05).

Conclusion

Spine surgeons should be aware of certain patient and procedure-specific characteristics that increase the risk of developing postoperative CSF leak after lumbar fusion in order to improve patient outcomes.

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Authors and Affiliations

  1. Rutgers New Jersey Medical School, 140 Bergen Street, Newark, NJ, 07103, USA

    Gabriel Hanna & Alejandro Pando

  2. Saint Joseph Regional Medical Center, Paterson, NJ, USA

    Stephen Saela & Arash P. Emami

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  1. Gabriel Hanna
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  2. Alejandro Pando
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Correspondence to Gabriel Hanna.

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Each author certifies that his or her institution approved the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at New Jersey Medical School, Newark, NJ, USA.

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Hanna, G., Pando, A., Saela, S. et al. Cerebrospinal fluid (CSF) leak after elective lumbar spinal fusion: Who is at risk?. Eur Spine J 31, 3560–3565 (2022). https://doi.org/10.1007/s00586-022-07383-9

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  • DOI: https://doi.org/10.1007/s00586-022-07383-9

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