Risk factors of cerebrospinal fluid leakage following posterior lumbar interbody fusion for lumbar degenerative disease: A retrospective observational study of 684 patients

This study holds the primary objective of confirming the risk factors for cerebrospinal fluid leakage (CSFL) following posterior lumbar interbody fusion for lumbar degenerative disease. The 684 patients who received posterior lumbar interbody fusion for lumbar degenerative disease at our hospital from 2017 to 2023 fell into the CSFL group (n = 115) or the control group (n = 569). We retrospectively recorded demographic, surgical, and radiographic data for the examination of the independent risk factors related to CSFL. Univariate and multivariate logistic regression analyses were conducted to more thoroughly measure their significance. The incidence of CSFL was 16.8% (115/684 patients). According to multivariate analysis, elderly individuals (age ≥ 60 years; odds ratio [OR], 1.601; 95% confidence interval [CI], 1.004-2.554; P = .048), patients with fusion levels ≥ 4 (OR, 3.665; 95% CI, 1.523-8.818; P = .004), patients with scoliosis (OR, 5.213; 95% CI, 1.380-19.698; P = .015), patients with spondylolisthesis (OR, 2.229; 95% CI, 1.382-3.595; P = .001), and patients with a duration of operation ≥ 250 minutes (OR, 8.586; 95% CI, 1.114-66.172; P = .039) could independently indicate the risk of CSFL. For patients with CSFL, obvious increases in postoperative drainage, lengths of stay, hospitalization costs, and frequency of blood transfusions, all with P < .001, were detected. Elderly age (≥60 years), fusion level ≥ 4, scoliosis, spondylolisthesis, and operative duration ≥ 250 minutes were identified as independent predictive factors for the risk of CSFL. CSFL patients had significantly more postoperative drainage, longer lengths of stay, higher hospitalization costs, and more frequent blood transfusions.