APPs in spinal CSF leak programs handle pre- and post-procedural care, while procedures remain physician-led, survey finds

In a survey of US spinal CSF leak programs, ≥75% of physician respondents strongly agreed that advanced practice providers (APPs) improved continuity of care, patient communication, clinic efficiency, and reduced physician burden, while procedural tasks remained physician-led.

• Twelve institutions participated; 67% cared for more than 250 spinal CSF leak patients per year, and 58% had APPs dedicated exclusively to this care. Training was informal on-the-job across all sites.
• Primary APP responsibilities included obtaining outside imaging, patient intake, procedure orders, consent, post-procedural follow-up, and pain management; physicians performed lumbar puncture, myelography, and CSF leak treatment.
• Perceived improvements included continuity of care, patient communication, clinic efficiency, and reduced administrative burden, but common barriers were funding/support, billing/reimbursement, and limited procedural privileges.

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