Sternocleidomastoid muscular flap: treatment of persistent cerebrospinal fluid leak after anterior cervical spine surgery.
METHODS
Retrospective review.


OBJECTIVE
To describe a novel application of rotational sternocleidomastoid (SCM) muscle flap in management of ventral cervical durotomy.


BACKGROUND
Even for the most experienced surgeons, incidental durotomy is a common occurrence in spine surgery. Primary direct suture repair is indicated to avoid possible complications such as pseudomeningocele or spinocutaneous fistula formation. Significant secondary effects of these complications have been described, including airway compromise, radiculopathy, myelopathy, and infection. When primary repair is not feasible, surgeons have used alternative management techniques based on their clinical judgment. In the setting of persistent symptomatic cerebrospinal fluid leak after repair, reoperation is warranted.


METHODS
A retrospective review was conducted of clinical records and radiographic data for 2 patients who underwent reoperation for management of ventral cervical durotomy encountered during anterior cervical spine surgery. SCM muscular flap was used to augment durotomy repair.


RESULTS
Both patients did not have any persistent cerebrospinal fluid leak after repair with pedicled SCM muscle flap, and did not require any further surgical procedures related to the cervical spine.


CONCLUSIONS
The use of a rotational SCM muscular flap may be useful in cases of ventral cervical durotomy refractory to conventional management.
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
John R
JR
Lien
Rakesh D
RD
Patel
Gregory P
GP
Graziano
D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D004388:Dura Mater / Q000601:surgery; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000098:blood supply / Q000601:surgery*; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome