Fat graft and paraspinal muscle flap were used in other 37 patients to reduce CSF leak, and they were assigned into fat graft and paraspinal muscle flap (FPM) group. Conventional suturing was used in 34 patients, and they were assigned into conventional suturing (CS) group. The patients were operated by the same surgeon. The average follow-up time was 15.10 ± 4.15 months. There were 25 (35.21%) men and 46 (64.79%) women who were enrolled in the present study, and their average age was 51.64 ± 11.92 years old. The exclusion criteria were as follows: (1) intraspinal tumors (2) spinal infectious diseases (3) a history of undergoing surgery involving spine (4) intraoperative application of special biomaterials (e.g., an artificial dura mater) (5) incomplete clinical data. The inclusion criteria were as follows: (1) patients who underwent thoracolumbar spine surgery (2) patients who underwent posterior surgery only (3) intraoperative CSF leak caused by incidental durotomy (4) patients who aged >18 years old (5) follow-up of at least 12-month. Study subjects and methods Study subjectsĭata of a total of 71 patients who were diagnosed with intraoperative incidental durotomy and CSF leak after posterior thoracolumbar surgery at the Third Hospital of Hebei Medical University (Shijiazhuang, China) form January 2019 to January 2021 were retrospectively collected and analyzed. This novel method may assist clinicians to reduce the influence of CSF leak. The present study aimed to propose a combined method using fat graft and paraspinal muscle flap, in order to treat CSF leak after posterior thoracolumbar surgery and to evaluate the clinical outcomes. Although different methods have been proposed to repair damaged dura mater and a variety of biological materials were used to block CSF leak, spinal surgeons still encounter numerous multifarious problems caused by CSF leak. CSF leak negatively affects clinical outcomes and patient satisfaction. Severe complications caused by CSF leak require revision surgery ( 3). Moreover, wound complications arose with the continuous outflow of CSF, such as nonunion, infection, and pseudomeningocele formation. Persistent postoperative CSF leak could lead to various low intracranial pressure symptoms, such as headache, dizziness, nausea, and vomiting ( 1, 4). In addition, intraoperative suturing does not always fully prevent outflow of CSF ( 8, 9). The effective treatment for CSF leak is dural suturing during surgery, however, anterior and a part of lateral dural rupture are difficult to suture.

As a common complication, the incidence rate of CSF leak ranges from 1% to 17.4% ( 4– 7). The proposed method showed satisfactory clinical outcomes, and it is worthy of promotion.Ĭerebrospinal fluid (CSF) leak after posterior thoracolumbar surgery is mainly caused by incidental durotomy intraoperatively, especially in the occasion of dural adhesion with surrounding tissue or abnormal ossification ( 1– 4). It also decreased the incidence and the degree of postural headache. The proposed method significantly reduced postoperative drainage tube time and postoperative drainage volume. Two patients underwent revision surgery resulting from incision nonunion and delayed meningeal cyst.Ĭonclusion: Fat graft combined with paraspinal muscle flap showed to be an effective method to repair CSF leak during posterior thoracolumbar surgery. There was a statistically significant difference in postoperative visual analogue scale (VAS) score between the two groups ( P = 0.013). Besides, 15 (44.11%) patients in the CS group complained of postural headache, which was more than that in the FPM group (7 patients, 18.91%). Results: The average drainage tube time in the FPM group was 3.89 ± 1.17 days, which was shorter than that in the CS group (5.12 ± 1.56, P < 0.001).

Patients’ demographic and clinical data were compared between the two groups.

Among them, 34 and 37 patients were assigned into conventional suturing (CS) group and fat graft and paraspinal muscle flap (FPM) group, respectively. Methods: Data of a total of 71 patients who were diagnosed with intraoperative incidental durotomy and CSF leak after posterior thoracolumbar surgery in our hospital form January 2019 to January 2021 were retrospectively collected and analyzed. The clinical outcomes were also evaluated. Objective: This study aimed to propose a novel surgical method via combination of fat graft and paraspinal muscle flap, in order to treat cerebrospinal fluid (CSF) leak during posterior thoracolumbar surgery.

Third Hospital of Hebei Medical University, Shijiazhuang, China.

Xianda Gao †, Peiyu Du †, Jiaxin Xu, Jiayuan Sun, Wenyuan Ding and Da-Long Yang*

Cerebrospinal fluid leak hospital