Document Detail

Cerebrospinal fluid leaks and their management after anterior cervical discectomy and fusion: a report of 13 cases and a review of the literature.
MedLine Citation:
PMID:  25010015     Owner:  NLM     Status:  In-Data-Review    
STUDY DESIGN: Retrospective medical record review and literature review.
OBJECTIVE: To identify cases where a cerebrospinal fluid (CSF) leak occurred during an anterior cervical discectomy and fusion (ACDF) and to create a management algorithm based on the findings.
SUMMARY OF BACKGROUND DATA: ACDF is a commonly performed spinal operation. It is effective with very low complication rates. One rare complication of ACDF is a CSF leak. There is limited information on the management of CSF leaks after ACDF and management is on a surgeon-by-surgeon basis.
METHODS: We reviewed 3 surgeons' case logs and identified cases where a CSF leak was encountered during ACDF and reviewed the patients' medical records, operative reports and imaging to determine how these leaks were managed. We also performed a PubMed search for articles about the presentation and management of CSF leaks after ACDF.
RESULTS: Thirteen CSF leaks were identified in 1223 ACDFs, corresponding to a CSF leak rate of 1%. Of these, 9 were successfully treated with intraoperative repair. Postoperative lumbar drainage was used in the remaining 4 patients and was successful in 1 patient. Three patients underwent neck re-exploration and attempted delayed repair. Three patients, including one who was found to have hydrocephalus, ultimately required continuous CSF diversion via shunting. We identified 7 case reports of CSF leak in ADCF in the literature and 1 article that reviewed the prevalence and management of this complication.
CONCLUSION: CSF leak after ACDF is an uncommon complication that can usually be repaired. We provide a stepwise management strategy for CSF leaks in ACDF.Level of Evidence: 5.
Peter Syre; Leif-Erik Bohman; Gordon Baltuch; Peter Le Roux; William C Welch
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  39     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2014 Jul 
Date Detail:
Created Date:  2014-07-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E936-43     Citation Subset:  IM    
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