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Cerebrospinal Fluid Leaks and Their Management After Anterior Cervical Discectomy and Fusion: A Report of 13 Cases and a Review of the Literature

Syre, Peter MD; Bohman, Leif-Erik MD; Baltuch, Gordon MD, PhD; Le Roux, Peter MD; Welch, William C. MD

doi: 10.1097/BRS.0000000000000404
Cervical Spine

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

Anterior cervical discectomy and fusion (ACDF) is commonly performed without complication. One complication of ACDF is a cerebrospinal fluid (CSF) leak. We identified 13 patients with this complication. A literature search identified reports of CSF leaks in ACDF. On the basis of these, we provide a management strategy of CSF leaks in ACDF.

From the Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania Hospital, Philadelphia, PA.

Address correspondence and reprint requests to Peter Syre, MD, Department of Neurosurgery, University of Pennsylvania, 3 Silverstein Pavilion, 3400 Spruce St, Philadelphia, PA 19104; E-mail:

Acknowledgment date: April 10, 2013. Revision date: March 24, 2014. Acceptance date: April 14, 2014.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants/grants pending, and expert testimony.

© 2014 by Lippincott Williams & Wilkins