Journal of Spine Practice

Published date: Jul 31 2025

Journal Title: Journal of Spine Practice

Issue title: Journal of Spine Practice (JSP): Volume 4, Issue 3

Pages: 116 - 125

DOI: 10.18502/jsp.v4i3.17930

Abdulhadi Y. Algahtanigahtaniay@gmail.comCollege of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah

Khalid Talal AlghamdiKh-t@hotmail.comDepartment of Neurosurgery, King Faisal Specialist Hospital and Research Center, Riyadh

Hamzah A. Alsharifalanizi.k@gmail.comKing Khalid Hospital, Ministry of Health, Najran

Ahood Ahmad A MahjariAhood.Mahjari@gmail.comKing Khalid Hospital, Ministry of Health, Najran

Abdulaziz M. AlghamdiAbdulazizmahdigh@gmail.comCollege of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah

Nawaf A. Bin Khamisnawafbinkhames@gmail.comCollege of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah

Reuof I. Althegfiryf0246@gmail.comCollege of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah

Alwaleed K. Aloufialoufi022@ksau-hs.edu.saCollege of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah

Wed Talal AlghamdiFaculty of Medicine. King Abdulaziz University, Jeddah

Hussein Matouq KheshaifatDr.hussein.kh@gmail.comNeuroscience Department, King Abdullah Medical City, Mecca

Background
Cerebrospinal fluid (CSF) leak is a known complication of spine surgery, and an effective protocol for prevention, recognition, and treatment of postoperative CSF leak is essential to avoid a cascade of associated adverse outcomes, such as durocutaneous fistula, wound infection, and intracranial hemorrhage. We aim to identify the incidence of CSF leak post spinal surgeries and to obtain the factors that could predict the risks of having a CSF leak following spine surgeries.

Methods
This study was conducted as a retrospective cohort study on patients who had CSF leaks post spinal surgery in King Abdul-Aziz Medical City, Jeddah, from June 2016 to January 2024.

Results
The occurrence of cerebrospinal fluid (CSF) leak post-surgery was relatively low (2.6%), and more than 97% of the participants studied had no CSF leak. There is a statistically insignificant relation with age, gender, DM, BMI, hypertension, malignancy, and cardiovascular diseases. Still, there is a statistically significant relation with the attempt to watertight closure, and type of surgery (P value ≤ 0.05).

Conclusion
Postoperative CSF leak following spinal surgery is associated with morbidity and can lead to re-operation and infection. The incidence of CSF leaks among our study participants was about 2.6%, which is relatively low. Identifying predictors for CSF leaks can assist in counseling patients concerning surgical risk and expected postoperative recovery.

Keywords: cerebrospinal fluid leak, CSF leak, pseudomeningocele, spine surgery, orthostatic headache, durotomy, dural tear, dural puncture

[1] Oshina M, Segawa T, Manabe N, Oshima Y, Tanaka S, Inanami H. Incidence, prognosis, and risk factors for bladder and bowel dysfunction due to incidental dural tears in lumbar microendoscopic surgery. Spine J. 2020 May;20(5):688-694. doi: 10.1016/j.spinee.2019.12.008. Epub 2019 Dec 19.

[2] Nakajima K, Nakamoto H, Kato S, Doi T, Matsubayashi Y, Taniguchi Y, Kawamura N, Higashikawa A, Takeshita Y, Fukushima M, Ono T, Hara N, Azuma S, Tanaka S, Oshima Y. Influence of unintended dural tears on postoperative outcomes in lumbar surgery patients: a multicenter observational study with propensity scoring. Spine J. 2020 Dec;20(12):1968-1975. doi: 10.1016/j.spinee.2020.06.009. Epub 2020 Jun 13.

[3] Ghobrial GM, Theofanis T, Darden BV, Arnold P, Fehlings GM, Harrop JS. Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature. Neurosurg Focus. 2015;39(4):E8.

[4] Jin JY, Yu M, Xu RF, Sun Y, Li BH, Zhou FF. Risk Factors for Cerebrospinal Fluid Leakage After Extradural Spine Surgery: A Meta-Analysis and Systematic Review. World Neurosurg. 2023 Nov;179:e269–80.

[5] Wong AP, Shih P, Smith TR, Slimack NP, Dahdaleh NS, Aoun SG, et al. Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foraminotomy, discectomy, or laminectomy. World Neurosurg. 2014 Mar;81(3- 4):634–40.

[6] Weber C, Piek, J, Gunawan, D. Health care costs of incidental durotomies and postoperative cerebrospinal fluid leaks after elective spinal surgery. Eur Spine J. 2015;24:2065-2068 (2015). https://doi.org/10.1007/s00586-014-3504-7.

[7] Menon SK, Onyia CU. A short review on a complication of lumbar spine surgery: CSF leak. Clin Neurol Neurosurg. 2015 Dec;139:248–51.

[8] Ivan ME, Iorgulescu JB, El-Sayed I, McDermott MW, Parsa AT, Pletcher SD, et al. Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery. J Clin Neurosci. 2015 Jan;22(1):48–54.

[9] Tang J, Lu Q, Li Y, Wu C, Li X, Gan X, et al. Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery. BMC Surg. 2022;22(1):30.

[10] Epstein NE. A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery. Surg Neurol Int. 2013 May;4(6 Suppl 5):S301–17.

[11] Guerin, Patrick, et al. Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury. 43.4 2012;43(4):397-401. https://doi.org/10.1016/j.injury.2010.12.014.

[12] Morishita S, Yoshii T, Okawa A, Fushimi K, Fujiwara T. Perioperative complications of anterior decompression with fusion versus laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament: propensity score matching analysis using a nation-wide inpatient database. Spine J. 2019;19(4):610–6.

[13] Hanna G, Pando A, Saela S, Emami AP. Cerebrospinal fluid (CSF) leak after elective lumbar spinal fusion: who is at risk? Eur Spine J. 2022;21(12):3560–5.

[14] Wang L, Yang L, Chu P. Risk factors analysis of postoperative cerebrospinal fuid leakage after lumbar posterior decompression fusion. Nurs Res Pract. 2021;18:1901–4.

[15] Zhu Md. [Risk Factors of Cerebrospinal Fluid Leakage in Lumbar Surgery and the Application Value of Hyperplastic Bone Knife,D]. Liaoning, China: chian. Med Univ. 2020.

[16] Wang Z, Lin B, Gao C, et al. Multiple factor analysis of cerebrospinal fluid leakage related to cervical spine surgery. Zhongguo Jizhu Jisui Zazhi. 2017;27:305–11.

[17] Kapadia BH, Decker SI, Boylan MR, Shah NV, Paulino CB. Risk factors for cerebrospinal fluid leak following anterior cervical discectomy and fusion. Clin Spine Surg. 2019;32(2):E86–90.

[18] Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental durotomy in spine surgery. Spine. 2000;25(20):2663–7.

[19] Khan MH, Rihn J, Steele G, Davis R, Donaldson WF 3rd, Kang JD, et al. Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine. 2006;31(22):2609–13.

[20] Meng Y, Shen B, Zhang Y, et al. Multivariate analysis of risk factors for cerebrospinal fluid leakage following lumbar laminectomy decompression with fusion. Zhongguo Jizhu Jisui Zazhi. 2013;23(4):330–4.

[21] Tuncer C, Gungor S, Ozturk K, Ozer AF. Treatment of postoperative cerebrospinal fluid leakage by blood patch method in patients undergoing vertebra surgery. J Turk Spinal Surg. 2021;32(4):260–5.

[22] Oh JW, Kim SH, Whang K. Traumatic cerebrospinal fluid leak: diagnosis and management. Korean J Neurotrauma. 2017;13(2):63–7.

[23] Nuyts M, Hemelryck W, Villeirs G, Vanmaele L, Loon JV. Use of acetazolamide in the postoperative care of endoscopic cerebrospinal fluid leak closure. Neurosurg Cases Rev. 2020;3:053.

[24] Chaaban MR, Illing E, Riley KO, Woodworth BA. Acetazolamide for high intracranial pressure cerebrospinal fluid leaks. Int Forum Allergy Rhinol. 2013;3(9):718–21.

[25] Hegazy HM, El-Bahy K, El-Hakim A, El-Fiki M, El-Kalliny M. Continuous lumbar drainage for the prevention and management of cerebrospinal fluid leaks. Asian J Neurosurg. 2019;14(1):1–6.

[26] Mammadkhanli O, Elbir C, Hanalioglu S, Canbay S. Subfascial drainage and clipping technique for treatment of cerebrospinal fluid leak following spinal surgery. Neurosciences (Riyadh). 2020;25(1):50–4.

[27] Tang J, Lu Q, Li Y, Zhang Y, Liu H. Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery. BMC Surg. 2022;22(1):30.