Introduction
Methods
Inclusion criteria
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SIH, according to the International Classification of Headache Disorders (ICHD-3) [20].
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Surgical treatment of a confirmed spinal CSF leak.
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Acute (start within 1 day) to subacute (start within 1 month) onset of clinical symptoms with a clear recall of the start of symptoms.
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Postoperative follow-up of at least 6 months.
Exclusion criteria
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No remembered onset of clinical symptomatology.
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Incidental diagnosis of spinal CSF loss without clinical symptomatology.
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No consent for the use of PROM data.
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No ability to complete the questionnaires.
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No reliable contact information for the automated follow-up.
Patient-reported outcome measures
SCQ
HIT-6
EQ-5D-5L
Clinical and diagnostic parameters
Diagnostics and surgical treatment
Statistics
Results
Patient population
Patient characteristics | N = 100 | |
---|---|---|
Female/male | 61/39 | |
Type of spinal CSF leak | ||
Ventral leak (Type 1) | 72 | |
Lateral leak (Type 2) | 21 | |
CSF-venous fistula (Type 3) | 7 |
Median (IQR) | Range | |
---|---|---|
Age (years) | 43.5 (36–53) | 24–78 |
Body Mass Index (BMI, kg/m2) | 23.9 (21.3–27.0) | 16.9–38.5 |
Duration of symptoms | ||
Months | 5 (2–15.3) | 0.3–157 |
Days | 173 (80–482) | 9–4792 |
Self-administered comorbidity questionnaire (SCQ) | ||
SCQ—Problem Score | 1 (0–2) | 0–6 |
SCQ—Treatment Score | 0 (0–1) | 0–5 |
SCQ—Limitation Score | 0 (0–1) | 0–4 |
SCQ—Summary Score | 1 (0–4) | 0–15 |
Patient-reported outcome
N | Preoperative Median (IQR) | 6 months postoperative Median (IQR) | p value | |
---|---|---|---|---|
Headache Impact Test (HIT-6) | ||||
All patients | 100 | 65.5 (61.8–69.3) | 51.5 (40.0–61.0) | < 0.001 |
Duration of symptoms < 90 days | 26 | 68.5 (65.0–71.0)** | 46.0 (40.0–57.5) | < 0.001 |
Duration of symptoms ≥ 90 days | 74 | 64.0 (61.0–68.0)** | 52.0 (44.0–61.8) | < 0.001 |
SCQ Summary Score ≤ 1 | 51 | 66.0 (63.0–70.0) | 48.0 (40.0–58.5) | < 0.001 |
SCQ Summary Score > 1 | 49 | 64.0 (61.0–69.0) | 52.0 (44.0–62.0) | < 0.001 |
EuroQol-5D-5L (EQ-5D-5L) | ||||
EQ-VAS | ||||
All patients | 100 | 40 (30–60) | 79 (60–90) | < 0.001 |
Duration of symptoms < 90 days | 26 | 46 (30–60) | 82 (69–94) | < 0.001 |
Duration of symptoms ≥ 90 days | 74 | 40 (30–65) | 75 (56–90) | < 0.001 |
SCQ Summary Score ≤ 1 | 51 | 46 (30–60) | 84 (67–93)** | < 0.001 |
SCQ Summary Score > 1 | 49 | 40 (30–60) | 71 (50–85)** | < 0.001 |
EQ-Index | ||||
All patients | 100 | 0.669 (0.345–0.799) | 0.910 (0.796–0.943) | < 0.001 |
Duration of symptoms < 90 days | 26 | 0.494 (0.210–0.793) | 0.923 (0.909–0.992)* | < 0.001 |
Duration of symptoms ≥ 90 days | 74 | 0.692 (0.480–0.799) | 0.881 (0.737–0.943)* | < 0.001 |
SCQ Summary Score ≤ 1 | 51 | 0.704 (0.343–0.814) | 0.918 (0.866–1.000)** | < 0.001 |
SCQ Summary Score > 1 | 49 | 0.656 (0.359–0.786) | 0.851 (0.734–0.934)** | < 0.001 |
The impact of symptom duration, comorbidity, and clinical parameters
Goodness-of-fit | Symptom duration (ln) (days) | SCQ Summary Score | Sex (m < f) | Age (years) | BMI (kg/m2) | Height (cm) | Leak type | |||
---|---|---|---|---|---|---|---|---|---|---|
Preoperative | ||||||||||
HIT-6 | R | 0.234 | B | − 1.1 | ||||||
Adj. R2 | 0.035 | 95% CI | − 2.2/0.2 | |||||||
p | 0.065 | p | 0.081 | > 0.1 | > 0.1 | > 0.1 | > 0.1 | > 0.1 | > 0.1 | |
EQ-VAS | R | 0.400 | B | − 1.9 | − 19.3 | − 87.9 | − 4.7 | |||
Adj. R2 | 0.096 | 95% CI | − 3.2/− 0.3 | − 31.1/− 6.5 | − 163.2/− 14.7 | − 9.2/0.5 | ||||
p | 0.021 | p | > 0.1 | 0.007 | 0.004 | > 0.1 | > 0.1 | 0.019 | 0.065 | |
EQ-Index | R | 0.484 | B | − 0.2 | ||||||
Adj. R2 | 0.176 | 95% CI | − 0.4/− 0.1 | |||||||
p | 0.001 | p | > 0.1 | > 0.1 | 0.003 | > 0.1 | > 0.1 | > 0.1 | > 0.1 | |
6 months postoperative | ||||||||||
HIT-6 | R | 0.323 | B | 0.9 | − 0.2 | 0.4 | ||||
Adj. R2 | 0.076 | 95% CI | 0.1/1.5 | − 0.3/0.0 | − 0.0/0.8 | |||||
p | 0.014 | p | > 0.1 | 0.011 | > 0.1 | 0.055 | 0.080 | > 0.1 | > 0.1 | |
EQ-VAS | R | 0.499 | B | − 3.1 | − 2.7 | |||||
Adj. R2 | 0.192 | 95% CI | − 5.8/− 0.5 | − 3.9/− 1.3 | ||||||
p | < 0.001 | p | 0.020 | 0.001 | > 0.1 | > 0.1 | > 0.1 | > 0.1 | > 0.1 | |
EQ-Index | R | 0.475 | B | − 0.03 | − 0.03 | |||||
Adj. R2 | 0.167 | 95% CI | − 0.06/− 0.01 | − 0.05/− 0.01 | ||||||
p | 0.001 | p | 0.035 | 0.006 | > 0.1 | > 0.1 | > 0.1 | > 0.1 | > 0.1 |