Investigation of the relationship between modified schober test and post spinal headache frequency in urological surgery patients undergoing spinal anesthesia: A prospective observational study

ABSTRACT INTRODUCTION AND AIM: Severe and prolonged post-dural puncture headache (PDPH) can lead to significant clinical and socioeconomic negative impacts (such as prolonged hospital stay and patient incapacity). Therefore, identifying risk factors for PDPH and developing optimal treatment methods is crucial. This study aimed to investigate the relationship between the Modified Schober Test a measure of lumbar flexion and PDPH in patients undergoing urological surgery. METHOD: Our study is a prospective observational study conducted on 124 male patients who underwent spinal anesthesia for urological surgery, after obtaining informed consent. Patients older than 18 years were included. The Modified Schober test was administered before spinal anesthesia, and data were recorded without intervention. Postoperative queries regarding PDPH were conducted via phone on the 2nd, 7th, and 14th days. RESULTS: Statistical analysis revealed significant differences between PDPH and Modified Schober values regarding needle size and the presence of nausea/vomiting (p<0.05). According to the results of multivariable logistic regression, the risk of developing PDPH decreases by 4.9% (1-0.951) as age increases. The cutoff point for the Modified Schober variable, with a classification of no PDPH vs. PDPH, was identified at 3.85 cm (n=37) (sensitivity 93.80%, specificity 38.00%). CONCLUSION: Our findings indicate that the use of a 22G spinal needle significantly increases the risk of PDPH, while a 25G needle decreases this risk. Although no statistical significance was found between patient age and PDPH, logistic regression analysis did show a significant difference. A significant difference was also noted between the Modified Schober test and PDPH. Additionally, nausea during the perioperative period emerged as a significant symptom and a factor increasing the severity of PDPH. Keywords: Post Spinal Headache, Modified Schober Test, Lumbar Flexion, Spinal Anesthesia