Skip to main content

Cerebrospinal Fluid Leak After Spine Surgery

  • Chapter
  • First Online:
The Resident's Guide to Spine Surgery

Abstract

Cerebrospinal fluid (CSF) leak is a common complication of spine surgery. There are various patient factors as well as technical issues that increase the risk for CSF leak during spine surgery. There are various techniques that can be utilized for treatment of this complication. All of these will be explored in depth in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Guerin P, El Fegoun AB, Obeid I, Gille O, Lelong L, Luc S, Bourghli A, Cursolle JC, Pointillart V, Vital JM. Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury. 2012;43:397–401.

    Article  Google Scholar 

  2. Wang JC, Bohlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg. 1998;80:1728–32.

    Article  CAS  Google Scholar 

  3. Wong AP, Shih P, Smith TR, Slimack NP, Dahdaleh NS, Aoun SG, El Ahmadieh TY, Smith ZA, Scheer JK, Koski TR, Liu JC, Fessler RG. Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foraminotomy, discectomy, or laminectomy. World Neurosurg. 2014;81:634–40.

    Article  Google Scholar 

  4. Epstein NE. The frequency and etiology of intraoperative dural tears in 110 predominantly geriatric patients undergoing multilevel laminectomy with noninstrumented fusions. J Spinal Disord Tech. 2007;20:380–6.

    Article  Google Scholar 

  5. 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. J Bone Joint Surg. 1992;74:270–7.

    Article  CAS  Google Scholar 

  6. Hannallah D, Lee J, Khan M, Donaldson WF, Kang JD. Cerebrospinal fluid leaks following cervical spine surgery. J Bone Joint Surg. 2008;90:1101–5.

    Article  Google Scholar 

  7. Menon SK, Onyia CU. A short review on a complication of lumbar spine surgery: CSF leak. Clin Neurol Neurosurg. 2015;139:248–51.

    Article  Google Scholar 

  8. Salmon B, Martin D, Lenelle J, Stevenaert A. Juxtafacet cyst of the lumbar spine. Clinical, radiological and therapeutic aspects in 28 cases. Acta Neurochir. 2001;143:129–34.

    Article  CAS  Google Scholar 

  9. Takahashi Y, Sato T, Hyodo H, Kawamata T, Takahashi E, Miyatake N, Tokunaga M. Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations: clinical article. J Neurosurg Spine. 2013;18:165–9.

    Article  Google Scholar 

  10. Kalanithi PA, Arrigo R, Boakye M. Morbid obesity increases cost and complication rates in spinal arthrodesis. Spine. 2012;37(11):982–8.

    Article  Google Scholar 

  11. Burks CA, Werner BC, Yang S, Shimer AL. Obesity is associated with an increased rate of incidental durotomy in lumbar spine surgery. Spine. 2015;40:500–4.

    Article  Google Scholar 

  12. Faraj AA, Webb JK. Early complications of spinal pedicle screw. Eur Spine J. 1997;6:324–6.

    Article  CAS  Google Scholar 

  13. Vakharia SB, Thomas PS, Rosenbaum AE, Wasenko JJ, Fellows DG. Magnetic resonance imaging of cerebrospinal fluid leak and tamponade effect of blood patch in postdural puncture headache. Anesth Analg. 1997;84:585–90.

    CAS  PubMed  Google Scholar 

  14. Kim KD, Wright NM. Polyethylene glycol hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair in the spine: results of a prospective, multicenter, randomized controlled study. Spine. 2011;36:1906–12.

    Article  Google Scholar 

  15. Desai A, Ball PA, Bekelis K, Lurie J, Mirza SK, Tosteson TD, Weinstein JN. SPORT: does incidental durotomy affect long-term outcomes in cases of spinal stenosis? Neurosurgery. 2015;76:S57–63.

    Article  Google Scholar 

  16. Jones AA, Stambough JL, Balderston RA, Rothman RH, Booth RE Jr. Long-term results of lumbar spine surgery complicated by unintended incidental durotomy. Spine. 1989;14:443–6.

    Article  CAS  Google Scholar 

  17. Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental durotomy in spine surgery. Spine. 2000;25:2663–7.

    Article  Google Scholar 

  18. Adogwa O, Huang MI, Thompson PM, Darlington T, Cheng JS, Gokaslan ZL, Gottfried ON, Bagley CA, Anderson GD, Isaacs RE. No difference in postoperative complications, pain, and functional outcomes up to 2 years after incidental durotomy in lumbar spinal fusion: a prospective, multi-institutional, propensity-matched analysis of 1,741 patients. Spine J. 2014;14:1828–34.

    Article  Google Scholar 

  19. Goodkin R, Laska LL. Unintended “incidental” durotomy during surgery of the lumbar spine: medicolegal implications. Surg Neurol. 1995;43(1):4–12; 12–4.

    Article  CAS  Google Scholar 

  20. Bosacco SJ, Gardner MJ, Guille JT. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res. 2001;389:238–47.

    Article  Google Scholar 

  21. McCudden CR, Senior BA, Hainsworth S, Oliveira W, Silverman LM, Bruns DE, Hammett-Stabler CA. Evaluation of high resolution gel β(2)-transferrin for detection of cerebrospinal fluid leak. Clin Chem Lab Med. 2013;51(2):311–5.

    Article  CAS  Google Scholar 

  22. Cain JE Jr, Dryer RF, Barton BR. Evaluation of dural closure techniques. Suture methods, fibrin adhesive sealant, and cyanoacrylate polymer. Spine. 1988;13:720–5.

    Article  Google Scholar 

  23. Dafford EE, Anderson PA. Comparison of dural repair techniques. Spine. 2015;15:1099–105.

    Article  Google Scholar 

  24. Sawamura Y, Asaoka K, Terasaka S, Tada M, Uchida T. Evaluation of application techniques of fibrin sealant to prevent cerebrospinal fluid leakage: a new device for the application of aerosolized fibrin glue. Neurosurgery. 1999;44:332–7.

    Article  CAS  Google Scholar 

  25. Jarzem P, Harvey EJ, Shenker R, Hajipavlou A. The effect of fibrin sealant on spinal fusions using allograft in dogs. Spine. 1996;21:1307–12.

    Article  CAS  Google Scholar 

  26. Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P, Cheng BC, Faught R, Welch WC. Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J. 2009;18:1169–74.

    Article  Google Scholar 

  27. Epstein NE. Dural repair with four spinal sealants: focused review of the manufacturers’ inserts and the current literature. Spine J. 2010;10:1065–8.

    Article  Google Scholar 

  28. Narotam PK, Jose S, Nathoo N, Taylon C, Vora Y. Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine. 2004;29:2861–7.

    Article  Google Scholar 

  29. Radcliff KE, Sidhu GD, Kepler CK, Gruskay J, Anderson DG, Hilibrand A, Albert TJ, Vaccaro AR. Complications of flat bed rest after incidental durotomy. Clin Spine Surg. 2016;29:281–4.

    Article  Google Scholar 

  30. Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet. 1999;354:1229–33.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Feinberg, M., Knudson, K., Martinez, J., Adams, C., Sweiss, F., Sherman, J.H. (2020). Cerebrospinal Fluid Leak After Spine Surgery. In: O'Brien, J., Kalantar, S., Drazin, D., Sandhu, F. (eds) The Resident's Guide to Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-20847-9_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-20847-9_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-20846-2

  • Online ISBN: 978-3-030-20847-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics