Prolonged Use of Subfascial Epidural Drain and Antibiotics for Management of Thoracic Cerebrospinal Fluid Leakage

Background: Cerebrospinal fluid (CSF) leakage is a common and frustrating complication surrounding spine surgery. However, the incidence and treatment of CSF leakage after thoracic spinal surgery has seldom been reported. The aim of this study was to evaluate the efficacy of prolonged subfascial epidural drain and antibiotics to treat CSF leakage after posterior thoracic decompression surgery. Methods: : A total of 121 patients, who underwent thoracic decompression between September 2012 to September 2021, were retrospectively reviewed, consisting of 56 patients with CSF leakage (Group A) and 65 without CSF leakage (Group B). Demographic data, surgical procedures, perioperative management of CSF leakage, and complications were identified from patients’ medical records. Results: : In Group A, the average patient age at surgery was 52.3±11.2 years (24 to 76 years) and the average subfascial drainage time was 7.6±2.7 days (2 to 16 days). Two patients from group A underwent direct dura repair, with one of which still presenting with CSF leakage postoperatively. Four patients (7.1%) presented with deep wound infection and were successfully managed with wound debridement or intravenous antibiotics. In group B, the average patient age was 54.9±11.9 years (25 to 80 years) and the average subfascial drainage time was 3.8±1.4 days (2 to 7 days). One patient (1.5%) had a superficial wound infection and was treated with antibiotics. No patients presented with wound dehiscence, wound exudation or CSF fistulation. No significant difference in infection rate was observed between the two groups. Conclusion: No significant difference in infection rates was observed between the patients with and without thoracic CSF leakage, who were treated with different protocol. Prolonged use of subfascial epidural drain and antibiotics can effectively manage thoracic CSF leakage due to dural tear in patients after thoracic decompression surgery.