Objective: To investigate the incidence and treatment of cerebrospinal fluid leakage due to late presentation of dural tears (LPDT) after lumbar surgery and provide new ideas and treatment options for clinical management. This study addresses a significant knowledge gap in the specific context of delayed CSF leaks, where diagnosis and management remain particularly challenging despite existing literature on CSF leaks in general.
Methods: Patients who underwent posterior lumbar surgery from January 2021 to December 2024 were selected. General patient information, cerebrospinal fluid leakage (CSF) characteristics, follow-up results, and re-examination data were analyzed using chi-squared tests, Fisher's exact tests, t-tests, and ANOVAto identify cases of LPDT, their treatment methods, complications, and clinical outcomes.
Results: A total of 2359 patients who underwent lumbar surgery were included in the study. CSF leakage occurred in 43 patients (1.82%). Dural tears (DT) leading to CSF leakage intraoperatively or within 5 days postoperatively were observed in 36 patients (1.53%), with 23 (0.98%) identified intraoperatively. Seven patients (0.30%) experienced CSF leakage due to LPDT: two of them underwent dural repair surgery 3 weeks and 4 months postoperatively, respectively; five patients received conservative treatment involving wound pressure bandage and bed rest. Clinical outcomes were favorable (good or excellent) in five patients (71.4%) and poor in two patients (28.6%) with LPDT, whereas in contrast, no poor outcomes were observed in non-LPDT patients.
Conclusion: This study found a 0.30% incidence of CSF leakage due to LPDT following lumbar surgery, with these patients demonstrating worse outcomes compared to those with nondelayed CSF leaks. CSF leakage secondary to unrecognized LPDT is an uncommon but clinically significant complication of spine surgery, necessitating heightened awareness and appropriate management.
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