{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:28Z","timestamp":1780736488226,"version":"3.54.1"},"reference-count":76,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>CSF leaks are a common complication of spinal surgery, occurring in 3%\u201316% of elective cases and up to 12% of operatively managed traumatic spinal injuries. They can also occur following lumbar puncture. However, there are limited data on utilization and reimbursement trends within Medicare for CSF leak repairs. Characterizing the economic burden and market of spinal CSF leak repair has implications for optimizing effective management strategies. This study evaluates reimbursement and utilization trends for both surgical repair and epidural blood patch (EBP) management of spinal CSF leaks between the years 2000 and 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The 2000\u20132021 provider utilization and payment files from the Centers for Medicare &amp; Medicaid Services was queried to identify all spinal CSF leak repair procedures billed to Medicare part B. For each management strategy, the number of procedures, total charges submitted by providers, and total Medicare reimbursements were extracted. Monetary data were adjusted to 2021 US dollars using changes to the Consumer Price Index. Spearman rank correlation coefficients were used to analyze trends in reimbursement and utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>From 2000 to 2021, 62,826 open surgical repairs were reported with $37,082,407 paid in reimbursement (45.9% repaired without additional laminectomy, 28.8% with laminectomy, and 25.3% requiring a spinal dural graft). An additional 63,227 EBPs were reported for CSF leak repair with $7,567,776 in reimbursement. Reimbursement for CSF leak repair without laminectomy totaled $15,707,094; repairs with laminectomy, $12,429,690; and use of spinal dural grafts, $8,945,444. Both a significant 162% increase in the utilization of spinal dural grafts (333 to 872, p &lt; 0.001) and a decrease in reimbursement ($671 to $496, p = 0.02) was observed from 2000 to 2021. There was a significant 31% decrease in reimbursement for EBP ($148 to $102, p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Significant variability exists in the management strategy and rates of utilization and reimbursement for treating spinal durotomy. Despite increasing utilization of spinal dural grafts, reimbursement has declined between the years 2000 and 2021. Further studies are required to optimize both the cost effectiveness and efficacy of spinal durotomy repair techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.11.focus24699","type":"journal-article","created":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T06:53:32Z","timestamp":1738392812000},"page":"E15","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Medicare procedural and reimbursement rates for spinal CSF leak repair (2000\u20132021)"],"prefix":"10.3171","volume":"58","author":[{"given":"Muhammad I.","family":"Jalal","sequence":"first","affiliation":[{"name":"University of Rochester School of Medicine and Dentistry, Rochester, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohin","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Santangelo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Schick","sequence":"additional","affiliation":[{"name":"University of Rochester School of Medicine and Dentistry, Rochester, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman","family":"Singh","sequence":"additional","affiliation":[{"name":"University of Rochester School of Medicine and Dentistry, Rochester, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Furst","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Stone","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Edward","family":"Vates","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Eur Spine J","first-page":"389","article-title":"Incidental dural tear in spine surgery: analysis of a nationwide database","volume":"23","author":"Yoshihara H","year":"2014","unstructured":"Yoshihara H, Yoneoka D. Incidental dural tear in spine surgery: analysis of a nationwide database. Eur Spine J. 2014;23(2):389\u2013394."},{"issue":"11","key":"b2","series-title":"Arch Orthop Trauma Surg","first-page":"1501","article-title":"Incidental dural tear in lumbar spinal decompression and discectomy: analysis of a nationwide database","volume":"133","author":"Yoshihara H","year":"2013","unstructured":"Yoshihara H, Yoneoka D. Incidental dural tear in lumbar spinal decompression and discectomy: analysis of a nationwide database. Arch Orthop Trauma Surg. 2013;133(11):1501\u20131508."},{"issue":"3","key":"b3","series-title":"J Neurosurg Spine","first-page":"224","article-title":"Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery","volume":"5","author":"Sin AH","year":"2006","unstructured":"Sin AH, Caldito G, Smith D, Rashidi M, Willis B, Nanda A. Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery. 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