Cerebrospinal fluid fistula secondary to dural tear in anterior cervical discectomy and fusion: case report.
METHODS
A case of cerebrospinal fistula secondary to a dural tear during anterior cervical discectomy and fusion.


OBJECTIVE
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.


BACKGROUND
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.


CONCLUSIONS
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.
Fountas
Kostas N
KN
Department of Neurosurgery, The Medical Center of Central Georgia, Mercer University School of Medicine, Macon, GA, USA. knfountasmd@excite.com
Kapsalaki
Eftychia Z
EZ
Johnston
Kim W
KW
D000328:Adult; D002555:Cerebrospinal Fluid; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects*; D004388:Dura Mater / Q000293:injuries* / Q000473:pathology; D005402:Fistula / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D013119:Spinal Cord Injuries / Q000209:etiology* / Q000473:pathology; D013123:Spinal Fusion