Incidence & Management of Delayed Cerebrospinal Fluid Leaks after Lumbar Spinal Surgery-Analysis of 10 Cases

Objectives: Cerebrospinal fluid (CSF) leaks in degenerative lumbar spine surgery are common, however, delayed cerebrospinal fluid (CSF) leaks are quite rare in neurosurgical practice. Literature regarding its incidence and management is scant.Our aim was to describe the incidence & management of delayed CSF leaks after degenerative lumbar spine surgery. Material & Methods: This was a prospective study where all patients operated for lumbar disc or stenosis, who presented with the delayed CSF leak (> 1 week postoperatively) without intraoperative record of incidental durotomy were included. Data was collected about demographics, diagnosis, operative detail, postoperative course & management issues. Results: Ten out of 1128 patients developed delayed CSF leaks (0.89%). Mean age at the time of diagnosis was 52.1 ± 6.9 years with 6 (60%) males & 4 (40%) female. The most common spinal level was L5-S1 (50%). Eighty percent (n = 8) patients underwent primary surgery while 20% (n = 2) were revisions. Clinical features were headaches (80%), dizziness (70%) and altered sensorium in 20%. Mean time of the leak was 17.3 ± 2.2 days. Two patients resolved with bed rest and compression dressing while the lumbar drain was placed in 80%. Three (30%) patients of the 8 needed open repair of the dural defect. Complications of the CSF leak included wound infection in 60%, and meningitis in one (10%) patient. There were no cases of neurologic deficit. One case eventually developed infective discitis.