Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 1;23(3):200-205.
doi: 10.1227/ons.0000000000000293. Epub 2022 Jun 14.

Efficacy and Safety of Subfascial Epidural Drainage Protocol After Intraoperative Durotomy in Posterior Thoracic and Lumbar Spine Surgery: Reoperation Prevention and Outcomes Among Drained and Undrained Cohorts

Christopher Wilson  1 , Luke McVeigh, Acacia Williams, Joseph Acchiardo, Jamie Bradbury
Affiliations

Efficacy and Safety of Subfascial Epidural Drainage Protocol After Intraoperative Durotomy in Posterior Thoracic and Lumbar Spine Surgery: Reoperation Prevention and Outcomes Among Drained and Undrained Cohorts

Christopher Wilson et al. Oper Neurosurg. .

Abstract

Background: Persistent cerebrospinal fluid (CSF) egress after durotomy in posterior thoracic or lumbar spine surgery may cause devastating complications. Persistent CSF leaks may require reoperation, which confers additional cost and morbidity.

Objective: To evaluate the efficacy of our subfascial epidural drainage protocol in the setting of durotomy to prevent reoperation.

Methods: A retrospective cohort study of drained and undrained cohorts was completed to identify factors associated with reoperation for persistent CSF leak-related symptoms. The efficacy and safety of this 7-day subfascial epidural drainage protocol was assessed by comparing reoperation incidence, perioperative complications, rehabilitation necessity, and readmissions.

Results: In total, 156 patients underwent subfascial epidural drainage, and 14 were not drained. Subfascial drainage for up to 7 days was associated with a significantly lower incidence of reoperation than no drainage (3.3% vs 14%, respectively; P = .03). Perioperative complication incidence was similar between cohorts (12.8% vs 21.4%, respectively; P = .37), and length of stay was unchanged regardless of drainage (median 7 days). Subfascial drainage conferred a nearly 2-fold relative risk reduction in inpatient rehabilitation requirement (RR 0.55) and 3-fold relative risk reduction in 30-day (RR 0.31) and 90-day readmission (RR 0.36). Factors associated with reoperation among drained patients included drainage longer than 7 days, tobacco use, age younger than 50 years, and longer segment operations. Revision spine surgery was associated with reoperation among undrained patients.

Conclusion: When followed after durotomy, our subfascial epidural drainage protocol results in fewer reoperations than in an undrained cohort without prohibitive cost and no added morbidity.

PubMed Disclaimer

References

    1. Woodroffe RW, Nourski KV, Helland LC, et al. Management of iatrogenic spinal cerebrospinal fluid leaks: a cohort of 124 patients. Clin Neurol Neurosurg. 2018;170:61-66.
    1. Sheinis D, Sheinis V, Benharroch D, Ohana N. Incidental durotomy following transforaminal lumbar interbody fusion performed with the modified Wiltse approach. J Neurol Surg A Cent Eur Neurosurg. 2020;81(5):399-403.
    1. Barber SM, Fridley JS, Konakondla S, et al. Cerebrospinal fluid leaks after spine tumor resection: avoidance, recognition and management. Ann Transl Med. 2019;7(10):217.
    1. Bydon M, De la Garza-Ramos R, Abt NB, et al. Durotomy is associated with pseudoarthrosis following lumbar fusion. J Clin Neurosci. 2015;22(3):544-548.
    1. Sun X, Sun C, Liu X, et al. The frequency and treatment of dural tears and cerebrospinal fluid leakage in 266 patients with thoracic myelopathy caused by ossification of the ligamentum flavum. Spine (Phila Pa 1976). 2012;37(12):E702-E707.

LinkOut - more resources