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Irradiation cited as risk factor for cerebrospinal fluid leakage after total en bloc spondylectomy
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Careful consideration of postoperative cerebrospinal fluid leakage should be given to patients with a history of surgical site irradiation who undergo total en bloc spondylectomy, according to the findings in a recently published study.
Researchers analyzed the risk of postoperative cerebrospinal fluid (CSF) leakage after total en bloc spondylectomy and analyzed potential factors for this complication. The study included 72 patients who underwent total en block spondylectomy.
Postoperative CSF leakage was observed in 17 patients (23.6%). Researchers noted the following factors were associated with postoperative CSF leakage: patient age 54 years or older, resection of three or more vertebral bodies, dural injury and preoperative surgical site irradiation. However, after a multivariate analysis, researchers found preoperative surgical site irradiation was the only statistically significant risk factor for the complication.
Overall, 13 patients with postoperative CSF leakage recovered on their own and the remaining four patients required reoperation. All of the patients requiring reoperation had a history of surgical site irradiation.
Researchers concluded surgeons must keep preoperative site irradiation in mind when performing this surgery, as treatment for CSF leakage can be time-consuming and difficult. – by Robert Linnehan
Disclosures: The researchers report no relevant financial disclosures.
Perspective
Back to TopAli A. Baaj, MD
En bloc spondylectomy is a complex spinal procedure that is indicated for the management of primary bone tumors of the spine. It is a high-risk procedure, with cerebrospinal fluid (CSF) leak being one of the most common complications. In this study, the authors reviewed risk factors for CSF leak during en bloc spondylectomy. Their postoperative CSF leak rate was 23.6%, but 76% of these patients did not require reoperation. Of interest, all four patients who required reoperation had a history of surgical site irradiation.
This is an important study that highlights several important concepts in the surgical management of spinal tumors. First, CSF leak is a common, but generally benign complication in these extensive surgical procedures. The patient should be counseled appropriately on this risk and the potential postoperative management strategies for CSF leaks, including need for reoperation. Second, irradiation is a significant risk factor for tissue scarring, and hence, the occurrence of CSF leak. Therefore, in many instances, it is safer to proceed with surgical resection before adjuvant therapy, when indicated. The risk of CSF leak, wound infection and delayed healing are all increased in patients who have had irradiation before surgery. The multidisciplinary team evaluating these patients should consider this.
In summary, this work addresses an important intraoperative complication of en bloc spondylectomy. Proper diagnosis, management and patient counseling is essential in these highly specialized surgical procedures
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