title: Is lumbar drainage of postoperative cerebrospinal fluid fistula after spine surgery effective?
abstract: OBJECTIVE
  This study is a retrospective consecutive case series analysis of 198 patients who underwent spine surgery between 2009 and 2010. The aim of this paper was to assess the efficacy and safeness of bed rest and lumbar drainage in treating postoperative CSF fistula. Postoperative cerebrospinal fluid (CSF) fistula is a well-known complication in spine surgery which lead to a significant change in length of hospitalization and possible postoperative complications. Management of CSF leaks has changed little over the past 20 years with no golden standard advocated from literature.
  
  
  METHODS
  Postoperative CSF fistulas were described in 16 of 198 patients (8%) who underwent spine surgery between 2009 and 2010. The choice of the therapeutic strategy was based on the clinical condition of the patients, taking into account the possibility to maintain the prone position continuously and the risk of morbidity due to prolonged bed rest. Six patients were treated conservatively (position prone for three weeks), ten patients were treated by positioning an external CSF lumbar drainage for ten days. The mean follow-up period was ten months.
  
  
  RESULTS
  All patients healed their wound properly and no adverse events were recorded. Patients treated conservatively were cured in a mean period of 30 days, while patients treated with CSF drainage were cured in a mean period of 10 days.
  
  
  CONCLUSIONS
  Lumbar drainage seems to be effective and safe both in preventing CSF fistula in cases of large dural tears and debilitated/irradiated patients and in treating CSF leaks.
authors.affiliation: Department of Oncologic and Degenerative Spine Surgery Rizzoli Orthopedic Institute, Bologna, Italy2 Department of Neurosurgery Bellaria‑Maggiore Hospital, Bologna, Italy3 Orthopedics and Traumatology Division Reggio Emilia Hospital, Reggio Emilia, Italy - giovanni@barbantibrodano.com.
authors.forename: G
authors.initials: G
authors.lastname: Barbanti Bròdano
authors.forename: E
authors.initials: E
authors.lastname: Serchi
authors.forename: L
authors.initials: L
authors.lastname: Babbi
authors.forename: S
authors.initials: S
authors.lastname: Terzi
authors.forename: A
authors.initials: A
authors.lastname: Corghi
authors.forename: A
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: S
authors.initials: S
authors.lastname: Bandiera
authors.forename: C
authors.initials: C
authors.lastname: Griffoni
authors.forename: S
authors.initials: S
authors.lastname: Colangeli
authors.forename: R
authors.initials: R
authors.lastname: Ghermandi
authors.forename: S
authors.initials: S
authors.lastname: Boriani
mesh_terms: D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects; D004388:Dura Mater / Q000601:surgery; D005260:Female; D005402:Fistula / Q000134:cerebrospinal fluid* / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome