Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foraminotomy, discectomy, or laminectomy.
OBJECTIVE
Minimally invasive spine surgery (MISS) techniques have similar long-term outcomes compared to open surgery for patients undergoing 1- or 2-level discectomy, foraminotomy, or laminectomy. However, the rate of cerebrospinal fluid (CSF) leaks with both techniques has not been well established in the literature. This study sought to compare the rate and clinical impact of CSF leak in open lumbar foraminotomy, discectomy, or laminectomy with comparable MISS approaches.


METHODS
A total of 863 patients undergoing 1- or 2-level discectomy, foraminotomy, or laminectomy by either MISS an open technique were evaluated for CSF leaks. Variables assessed included operative time, blood loss, CSF leaks, hospital stay, days with lumbar drain, days of postoperative flat bed rest, and postoperative intervention. Statistical analyses include univariate analysis (Student t test, analysis of variance, odds ratio, χ(2)) and bivariate analysis (logistic regression).


RESULTS
In the MISS group there were 15 CSF leaks (4.7%), and 49 CSF leaks (9.0%) in the open group. Eight patients in the open group required lumbar drainage, compared to zero patients in the MISS group. Twelve patients required reoperation for persistent CSF leak in the open group, compared to zero patients in the MISS group. Patients undergoing open spine surgery were 2 times more likely to have a CSF leak (odds ratio = 2.3, 95% confidence interval = 1.2 to 3.7, P = .01). Patients undergoing MISS had significantly lower reoperation rates for CSF leak repairs (open = 25% of open CSF leak cases, MISS = 0%, P < .01).


CONCLUSIONS
In this study, there was a statistically significant decreased rate of CSF leak between an MISS approach and an open surgical approach. Furthermore, CSF leaks in open surgery have a higher probability of requiring lumbar drainage or reoperation to repair the durotomy.
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Albert P
AP
Wong
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Patrick
P
Shih
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Timothy R
TR
Smith
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Nicholas P
NP
Slimack
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Nader S
NS
Dahdaleh
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Salah G
SG
Aoun
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Tarek Y
TY
El Ahmadieh
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Zachary A
ZA
Smith
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Justin K
JK
Scheer
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Tyler R
TR
Koski
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
John C
JC
Liu
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: rfessler@rush.edu.
Richard G
RG
Fessler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology*; D016208:Databases, Factual; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods; D004388:Dura Mater / Q000601:surgery; D005260:Female; D059526:Foraminotomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D015999:Multivariate Analysis; D012189:Retrospective Studies; D055815:Young Adult
CSF leak; Cerebral spinal fluid leak; Discectomy; Durotomy; Laminectomy; Minimally invasive surgery; Spine surgery