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Dural tear and resultant cerebrospinal fluid leaks after cervical spinal trauma

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Abstract

Purpose

Traumatic cervical spinal cord injuries (SCIs) frequently develop dural tears and resultant cerebrospinal fluid (CSF) leaks. They are not usually identified with advanced imaging, and there are no reports on managing CSF leaks after cervical trauma. Hence, the authors evaluated the incidence of CSF leaks after cervical SCIs and described how to predict and manage CSF leaks.

Methods

An observational retrospective study was done confirming intraoperative CSF leaks among 53 patients with anterior cervical surgery after cervical spine trauma between 2004 and 2011.

Results

Seven patients (13.2 %) had dural tears and resultant CSF leaks intraoperatively (M:F ratio of 6:1; mean age, 44.7 years). An initial poor American Spinal Injury Association (ASIA) scale was significantly associated with CSF leaks (p = 0.009). From magnetic resonance imaging (MRI), disruption of the ligamentum flavum was correlated with CSF leaks (p = 0.02). Intraoperative application of fibrin glue on the operated site, postoperative management through the early removal of the wound drain within the first 24 h and early rehabilitation were performed in patients with CSF leaks without perioperative insertion of a lumbar drain. During the follow-up period, none of the patients developed CSF-leak-related complications.

Conclusion

The incidence of CSF leaks after traumatic cervical SCI is relatively higher than that of degenerative cervical spinal surgery. An initial poor neurological status and disruption of the ligamentum flavum on the MRI in patients were predictable factors of dural tears and CSF leaks.

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Acknowledgments

The authors would like to express their appreciation for the statistical analysis done by the Medical Research Collaborating Center at Seoul National University Hospital and the Seoul National University College of Medicine. This work was supported by the Global Frontier R and D Program on <Human-centered Interaction for Coexistence> funded by the National Research Foundation of Korea grant funded by the Korean Government (MEST) (NRF-2012M3A6A3055889).

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yeongun-Dong, Jongno-Gu, Seoul, 110-744, Korea

    Soo Eon Lee, Chun Kee Chung, Tae-Ahn Jahng & Chi Heon Kim

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  1. Soo Eon Lee
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  2. Chun Kee Chung
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  3. Tae-Ahn Jahng
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Correspondence to Chun Kee Chung.

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Lee, S.E., Chung, C.K., Jahng, TA. et al. Dural tear and resultant cerebrospinal fluid leaks after cervical spinal trauma. Eur Spine J 23, 1772–1776 (2014). https://doi.org/10.1007/s00586-014-3332-9

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  • DOI: https://doi.org/10.1007/s00586-014-3332-9

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