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  • CSF Leaks and Their Management Following Anterior Cervical Discectomy and Fusion: A Report of 13 Cases, Review of the Literature and Stepwise Management Strategy

    Final Number:

    Peter Syre MD; Leif-Erik Bohman MD; Peter D. LeRoux MD; Gordon H. Baltuch MD, PhD; William Charles Welch MD FACS FICS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Anterior cervical discectomy and fusion (ACDF) is a commonly performed spinal operation. It is effective with very low complication rates.[1-3] One rare complication of ACDF is a CSF leak.[4] There is limited information on the management of CSF leaks following ACDF and management is on a surgeon-by-surgeon basis. As such, the aim of this study was to to identify cases where a CSF leak occurred during an ACDF and to review the literature to create a management algorithm based on the findings.

    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 following ACDF.

    Results: Thirteen CSF leaks were identified in 1223 ACDFs (Table 1), 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

    Conclusions: CSF leak following ACDF is an uncommon complication that can usually be repaired. We provide a stepwise management strategy for CSF leaks in ACDF. (Figure 1)

    Patient Care: There is little documented on CSF leaks in ACDF and there is little information regarding the management of this complication. With the results of our research we feel that we can fill this void of knowledge via both a review of the literature and a guideline for the management of a CSF leak following an ACDF procedure, thus improving patient care following this complication.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify the complications encountered during ACDF, 2)Describe the CSF leak rate in ACDF, 3) Discuss the management strategy and management options of a patient who underwent an ACDF and had a CSF leak during the procedure, 4) Discuss the literature regarding CSF leaks as a complication of ACDF.

    References: 1. Angevine PD, Arons RR, McCormick PC. National and regional rates and variation of cervical discectomy with and without anterior fusion, 1990–1999. Spine 2003;28:931–940. 2. Sampath P, Bendebba M, Davis JD, Ducker T. Outcome in patients with cervical radiculopathy. Prospective, multicenter study with independent clinical review. Spine. 1999;24(6):591-597. 3. Ghogawala Z, Martin B, Benzel EC, et al. Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy. Neurosurgery. 2011;68(3):622-630. 4. Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine 2007;32(21):2310-2317. Review.

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