• Kazuyoshi Kobayashi, Kei Ando, Kenyu Ito, Mikito Tsushima, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Naoki Ishiguro, and Shiro Imagama.
• Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya 466-8550, Japan.
• J Orthop Sci. 2018 Mar 1; 23 (2): 266-272.

BackgroundPostoperative cerebrospinal fluid (CSF) leakage is a major clinical problem, and prevention of CSF leakage at the surgical site is an important issue. The goal of the study was to evaluate the efficacy of intraoperative lumbar subarachnoid drainage (LSAD) for prevention of CSF leakage after spinal cord tumor resection.MethodsThe subjects were 97 patients with a cervical or thoracic primary intradural spinal cord tumor who underwent surgery at our hospital. A LSAD catheter was placed in the lumbar thecal sac before incision and left in place for several days postoperatively. Age, tumor level, number of laminectomy levels, operation time, estimated blood loss (EBL) intraoperatively, use of artificial dura mater, white blood cell (WBC) counts and C-reactive protein (CRP) levels on postoperative days (PODs) 3 and 10, subcutaneous CSF accumulation at the operation site, and postoperative complications were examined retrospectively.ResultsLSAD of CSF was performed in 35 patients. In this group, the drainage catheter was left in place for an average of 4.9 (range 3-8) days. Use of artificial dura mater was significantly higher and CRP on POD 10 was significantly lower in the drainage group. Subcutaneous accumulation of CSF due to leakage was significantly higher in patients with cervical lesions than in those with thoracic lesions. In cases in which artificial dura mater was used, CSF leakage occurred at a significantly lower rate in the drainage group. Without use of an artificial dura mater, CSF leakage did not differ significantly between the two groups.ConclusionLumbar subarachnoid CSF drainage was associated with a significant decrease in postoperative CRP. In cases in which artificial dura mater was used and in surgery for a cervical lesion, drainage was useful to prevent subcutaneous CSF accumulation.Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

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