Observation Of Therapeutic Effect Of Pressure Dressing On Cerebrospinal Fluid Leakage After Spinal Surgery

Background and ObjectiveBackground: Cerebrospinal fluid leakage is a common complication in spine surgeries,its incidence rate is rising with the increase of numbers and complexities of spine surgery.it may lead to poor wound healing,wound infection,pseudomeningeole or even neurological infection,intracranial hemorrhage and other life-threatening complications if handled improperly.Conventional postoperative treatment include various forms of cerebrospinal fluid diversion,body positioning,timely dressing change,extended drainage time,and intermittent clamping of the drainage tube.Their effectiveness has been confirmed after long-term clinical practice,but there also exist various corresponding complications.For example,there may be complications related to intracranial hypotension due to excessive cerebrospinal fluid diversion,poor compliance and long-term bed rest related complications in body positioning,and other factors such as the complexity of the operation process that have limited the routine application of these methods in clinical practice.Physiologically pressure dressing has less impact on subdural pressure and can reduce collection of CSF in the wound,so to promote its healing,however there are few relative research about it.Objective: To research the therapeutic effect of pressure dressing for CSFL in posterior spine surgery.MethodA retrospective analysis of 24 cases suffered cerebrospinal fluid leakage after spinal surgery from September 2017 to September 2019 in our department was taken.Cases are separated into two groups(A,B)based on different post operation treatments.The group A consisted of 13 cases which adopt pressure dressing as treatment,while the control group(B)in which the dressings are regularly changed consisted of 11 cases.The dura lesions are repaired with running suture if possible,with stich length <3mm.When the defect of dura is too large or is located ventrally or near nerve root sleeve,artificial dura patches are used for repairment.Deep fascia layers should be sutured tightly and to supraspinous ligaments if spinous process is preserved.Atmospheric pressure drainage is used if dura lesion occurred intraoperatively,negative pressure drainage should be changed atmospherically if CSFL happens after surgery.When the fluid collected inside the drainage bag is less than 30 ml,and the color is clear should the drainage tube be removed.If fluid collection is clear after 3-4 days but the volume is still large,drainage tube should be clipped for 8-12 hours to see if any neurological symptoms occurs,occlusion time should be prolonged if not,until the drainage volume is less than 30 ml in 24 h could the drainage tube be removed.Ultrasound examination are regularly taken before discharge,statistics are taken to compared the therapeutic results between two groups.ResultsStatistics of 24 cases with postoperative cerebral spinal fluid leakage of spine surgery are as follows: 2 out of 13 patients(15.4%)of the compressed dressing group(A)have subcutaneous edema,all 13 cases have CSFL controlled successfully(100%).Average volume of drainage collected every day is 270.25±68.96ml/d,days taken for cease of drainage are 5~9d,average number is 6.92 ± 1.19 d,volume of drainage totally collected for is 1863.08±545.74 ml,max volume of drainage collected per day is 495.38±96.68 ml.There are 2 patients out of 13(15.4%)in group A who developed hypotension syndrome related complications.There is 1 patient who had a drenched dressing 3 days after surgery,about 2cm long poorly healed wound was found 1cm from the head end and had cerebral spinal fluid leak through,after sutured deeply and compressed locally,the wound healed primarily 3 weeks after surgery.The rest of 11 cases of group A are primarily healed,there is 1 patient who has 2 sites where the wound healed poorly,both about 0.5cm(Pic 5),however evidence of infection was not found,there is neither a collection of blood or fluid,and finally healed 1 week later after treated with physical therapy.While 10 out 11 patients(90.9%)of group B have subcutaneous edema,8 patients have CSFL controlled(72.7%),while the rest 3 whose volume of drainage seemed not to decrease at all are changed into compressed dressing instead,and drainage stopped later.Average volume of drainage collected every day is 338.27±47.16ml/d,days taken for cease of drainage are 8~17d,average number is 10.82±2.71 d,volume of drainage totally collected is 3644.55±1085.70 ml,max volume of cerebral drainage collected per day are 620.91±131.30 ml.There are 7 out of 11(63.6%)patients who developed hypotension syndrome related headache and dizzy.There are 4 out of 11 patients in group B 1 day and 1 patient 3 days after surgery who had CSF leak through wounds,dressings were changed 1-4 times accordingly.There is 1 patient who had his wound infected 11 days after surgery and finally treated with debridement.The differences between two groups considering average volume of drainage collected every day,days taken for cease of drainage,volume of drainage totally collected,and max volume of drainage collected per day are statistically significant(P<0.05).The rate for successfully control of CSFL of group A(100%)is higher to that of group B(72.7%).The rate of cerebral hypotension syndrome of group A(15.4%)is lower than that of group B(63.6%).ConclusionsThe treatment pressure dressing can promote wound healing by reduce dead space inside the wound,and cause less cerebral hypotension syndrome related complication.It has good clinical outcomes and can be used routinely for CSFL after posterior spine surgery.