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  • Title: Cerebrospinal fluid fistula secondary to dural tear in anterior cervical discectomy and fusion: case report.
    Author: Fountas KN, Kapsalaki EZ, Johnston KW.
    Journal: Spine (Phila Pa 1976); 2005 May 15; 30(10):E277-80. PubMed ID: 15897820.
    Abstract:
    STUDY DESIGN: A case of cerebrospinal fistula secondary to a dural tear during anterior cervical discectomy and fusion. OBJECTIVES: To report a quite rare complication associated with anterior cervical discectomy and remind the spinal surgeons that this infrequent complication can easily become a very serious one. SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy represents one of the most commonly performed spinal procedures. Of the associated complications, accidental dural tear can lead to the development of a cerebrospinal fluid (CSF) fistula. Although this complication has been mentioned in several clinical series, the body of knowledge regarding incidence and appropriate treatment is definitely limited. METHODS: After undergoing anterior cervical discectomy and fusion for an extruded disc at the C4-C5 level, a CSF fistula developed in a 37-year-old patient as a result of a dural tear. The patient underwent a second procedure for surgical wound revision, meticulous dural opening coverage, and insertion of a lumbar drain for draining CSF for 5 days. RESULTS: The patient was hospitalized for 5 days and then discharged with no evidence of CSF leakage. His follow-up of 9 months revealed complete resolution of his preoperative symptomatology and no other problems associated with the complication of the CSF fistula. CONCLUSION: Early identification of this complication and aggressive treatment with insertion of lumbar drain, CSF drainage for 4-5 days, and coverage of the dural tear with fibrin sealant or autologous fascia graft can prevent the development of any consequences.
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