The drainage volume control by elevation of drainage height versus head down tilt in supine position for management of cerebrospinal fluid leakage following lumbar posterior surgery

Abstract

Abstract Objective To compare the clinical outcomes of control of drainage volume through either elevating the drainage height or tilting the head down in a supine position for the management of cerebrospinal fluid leakage (CSFL) following posterior lumbar surgery. Methods A retrospective analysis was conducted to review the data of patients who underwent lumbar spine surgery at a single hospital over a 4-year period from January 2020 to December 2023. Postoperative CSFL and complications were recorded. All patients with CSFL were managed with bed rest, a 20–30° head-down tilt position, or a drainage system elevated by 10 cm, along with subfascial drains, for a duration of 3 days. The clinical outcomes of drainage volume control were compared between the elevation of the drainage system and the head-down tilt position in the supine posture. Results The incidence of CSFL after lumbar surgeries was 1.2% (84 out of 7,284 cases). None of the CSFL patients experienced significant complications or required reoperation. When compared to the traditional Trendelenburg position, elevating the drainage height reduced the incidence of headache and dizziness, as well as shortened the time to ambulation, postoperative defecation time, and postoperative hospital stay, with statistically significant differences (p < 0.05). Conclusion Postoperative drainage volume control using the Trendelenburg position or elevation of the drainage height is both safe and effective for the management of CSFL. The method involving a 10 cm elevation of the drainage system appears to be an easier and more clinically acceptable approach for the nursing care of CSFL following posterior lumbar surgery.

Keywords

• Dural tear
• Degenerative lumbar surgery
• Complication
• Subfascial drains