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Management of Cerebrospinal Fluid Leak after Traumatic Cervical Spinal Cord Injury  

Lee, Soo Eon (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine)
Chung, Chun Kee (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine)
Jahng, Tae-Ahn (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine)
Kim, Chi Heon (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine)
Publication Information
Journal of Trauma and Injury / v.26, no.3, 2013 , pp. 151-156 More about this Journal
Abstract
Purpose: Traumatic cervical SCI is frequently accompanied by dural tear and the resulting cerebrospinal fluid (CSF) leak after surgery can be troublesome and delay rehabilitation with increasing morbidity. This study evaluated the incidence of intraoperative CSF leaks in patients with traumatic cervical spinal cord injury (SCI) who underwent anterior cervical surgery and described the reliable management of CSF leaks during the perioperative period. Methods: A retrospective study of medical records and radiological images was done on patients with CSF leaks after cervical spine trauma. Results: Seven patients(13.2%) were identified with CSF leaks during the intraoperative period. All patients were severely injured and showed structural abnormalities on the initial magnetic resonance image (MRI) of the cervical spine. Intraoperatively, no primary repair of dural tear was attempted because of a wide, rough defect size. Therefore, fibrin glue was applied to the operated site in all cases. Although a wound drainage was inserted, it was stopped within the first 24 hours after the operation. No lumbar drainage was performed. Postoperatively, the patients should kept their heads in an elevated position and early ambulation and rehabilitation were encouraged. None of the patients developed complications related to CSF leaks during admission. Conclusion: The incidence of CSF leaks after surgery for cervical spinal trauma is relatively higher than that of cervical spinal stenosis. Therefore, one should expect the possibility of a dural tear and have a simple and effective management protocol for CSF leaks in trauma cases established.
Keywords
Spine trauma; Cerebrospinal leakage; Dura tear; Cervical spine;
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1 Foyt D, Johnson JP, Kirsch AJ, Bruce JN, Wazen JJ. Dural closure with laser tissue welding. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 1996; 115(6): 513-8. Epub 1996/12/01.   DOI   ScienceOn
2 Sohn S, Chung CK, Kim CH. Is closed-suction drainage necessary after intradural primary spinal cord tumor surgery? European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2012. Epub 2012/09/25.
3 Chen TY, Crawford NR, Sonntag VK, Dickman CA. Biomechanical effects of progressive anterior cervical decompression. Spine. 2001; 26(1): 6-13; discussion 4. Epub 2001/01/10.   DOI   ScienceOn
4 Wang X, Chen Y, Chen D, Yuan W, Zhao J, Jia L, et al. Removal of posterior longitudinal ligament in anterior decompression for cervical spondylotic myelopathy. Journal of spinal disorders & techniques. 2009; 22(6): 404-7. Epub 2009/08/05.   DOI   ScienceOn
5 Shapiro SA, Scully T. Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. Neurosurgery. 1992; 30(2): 241-5. Epub 1992/02/01.   DOI
6 Coplin WM, Avellino AM, Kim DK, Winn HR, Grady MS. Bacterial meningitis associated with lumbar drains: a retrospective cohort study. Journal of neurology, neurosurgery, and psychiatry. 1999; 67(4): 468-73. Epub 1999/09/16.   DOI
7 Graf CJ, Gross CE, Beck DW. Complications of spinal drainage in the management of cerebrospinal fluid fistula. Journal of neurosurgery. 1981; 54(3): 392-5. Epub 1981/03/01.   DOI
8 Weill-Engerer S, Meaume S, Lahlou A, Piette F, Saint-Jean O, Sachet A, et al. Risk factors for deep vein thrombosis in inpatients aged 65 and older: a case-control multicenter study. Journal of the American Geriatrics Society. 2004; 52(8): 1299-304. Epub 2004/07/24.   DOI   ScienceOn
9 Joseph V, Kumar GS, Rajshekhar V. Cerebrospinal fluid leak during cervical corpectomy for ossified posterior longitudinal ligament: incidence, management, and outcome. Spine. 2009; 34(5): 491-4. Epub 2009/02/28.   DOI   ScienceOn
10 Eismont FJ, Wiesel SW, Rothman RH. Treatment of dural tears associated with spinal surgery. The Journal of bone and joint surgery American volume. 1981; 63(7): 1132-6. Epub 1981/09/01.
11 Mazur M, Jost GF, Schmidt MH, Bisson EF. Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature. Neurosurgical focus. 2011; 30(3): E13. Epub 2011/ 03/03.
12 Guerin P, El Fegoun AB, Obeid I, Gille O, Lelong L, Luc S, et al. Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury. 2012; 43(4): 397-401. Epub 2011/01/22.   DOI   ScienceOn
13 Goodkin R, Laska LL. Unintended "incidental" durotomy during surgery of the lumbar spine: medicolegal implications. Surgical neurology. 1995; 43(1): 4-12; discussion -4. Epub 1995/01/01.
14 Khan MH, Rihn J, Steele G, Davis R, Donaldson WF, 3rd, Kang JD, et al. Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine. 2006; 31(22): 2609-13. Epub 2006/10/19.   DOI   ScienceOn
15 Co. T. Resource for the optimal care of the injured patient. Chicago: Committee on Trauma. 1999.
16 Hannallah D, Lee J, Khan M, Donaldson WF, Kang JD. Cerebrospinal fluid leaks following cervical spine surgery. The Journal of bone and joint surgery American volume. 2008; 90(5): 1101-5. Epub 2008/05/03.   DOI   ScienceOn
17 Leucht P, Fischer K, Muhr G, Mueller EJ. Epidemiology of traumatic spine fractures. Injury. 2009; 40(2): 166-72. Epub 2009/02/24.   DOI   ScienceOn
18 Kitchel SH, Eismont FJ, Green BA. Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. The Journal of bone and joint surgery American volume. 1989; 71(7): 984-7. Epub 1989/08/01.
19 Smith MD, Bolesta MJ, Leventhal M, Bohlman HH. Postoperative cerebrospinal-fluid fistula associated with erosion of the dura. Findings after anterior resection of ossification of the posterior longitudinal ligament in the cervical spine. The Journal of bone and joint surgery American volume. 1992; 74(2): 270-7. Epub 1992/02/01.
20 Kraus JF, Franti CE, Riggins RS, Richards D, Borhani NO. Incidence of traumatic spinal cord lesions. Journal of chronic diseases. 1975; 28(9): 471-92. Epub 1975/10/01.   DOI   ScienceOn
21 Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal cord. 2012; 50(5): 365- 72. Epub 2012/01/25.   DOI   ScienceOn
22 Aarabi B, Alexander M, Mirvis SE, Shanmuganathan K, Chesler D, Maulucci C, et al. Predictors of outcome in acute traumatic central cord syndrome due to spinal stenosis. Journal of neurosurgery Spine. 2011; 14(1): 122-30. Epub 2010/12/21.   DOI   ScienceOn
23 Hohl JB, Lee JY, Horton JA, Rihn JA. A novel classification system for traumatic central cord syndrome: the central cord injury scale (CCIS). Spine. 2010; 35(7): E238-43. Epub 2010/03/17.
24 Dvorak MF, Fisher CG, Fehlings MG, Rampersaud YR, Oner FC, Aarabi B, et al. The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine. 2007; 32(23): 2620-9. Epub 2007/11/06.   DOI   ScienceOn
25 Merriam WF, Taylor TK, Ruff SJ, McPhail MJ. A reappraisal of acute traumatic central cord syndrome. The Journal of bone and joint surgery British volume. 1986; 68(5): 708-13. Epub 1986/11/01.
26 Lamothe G, Muller F, Vital JM, Goossens D, Barat M. Evolution of spinal cord injuries due to cervical canal stenosis without radiographic evidence of trauma (SCIWORET): a prospective study. Annals of physical and rehabilitation medicine. 2011; 54(4): 213-24. Epub 2011/03/23.   DOI   ScienceOn
27 Bosch A, Stauffer ES, Nickel VL. Incomplete traumatic quadriplegia. A ten-year review. JAMA: the journal of the American Medical Association. 1971; 216(3): 473-8. Epub 1971/04/19.   DOI   ScienceOn
28 Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman RA, Jr., et al. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine. 2007; 32(21): 2365-74. Epub 2007/10/02.   DOI   ScienceOn
29 Cammisa FP, Jr., Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental durotomy in spine surgery. Spine. 2000; 25(20): 2663-7. Epub 2000/10/18.   DOI   ScienceOn