title: Management of Persistent Cerebrospinal Fluid Leakage Following Thoraco-lumbar Surgery.
abstract: METHODS
  This was a retrospective study of patients who had developed a dural tear after thoracic and lumbar spine surgery that was not recognized during the surgery, and was treated either by lumbar drainage or over-sewing of the wounds.
  
  
  OBJECTIVE
  To revisit the treatment strategies in postoperative dural leaks and present our experience with over-sewing of the wound and lumbar drainage.
  
  
  BACKGROUND
  Unintended durotomy is a frequent complication of spinal surgery. Management of subsequent cerebrospinal fluid leakage remains controversial. There is no distinct treatment guideline according to the etiology in the current literature.
  
  
  METHODS
  The records of 368 consecutive patients who underwent thoracic and/or lumbar spine surgery from 2006 throug h 2010 were retrospectively reviewed. Seven cerebrospinal fluid fistulas and five pseudomeningoceles were noted in 12 (3.2%) procedures. Cerebrospinal fluid diversion by lumbar drainage in five pseudomeningoceles and over-sewing of wounds in seven cerebrospinal fluid fistulas employed in 12 patients. Clinical grading was evaluated by Wang.
  
  
  RESULTS
  Of the 12 patients who had a dural tear, 5 were managed successfully with lumbar drainage, and 7 with oversewing of the wound. The clinical outcomes were excellent in 9 patients, good in 2, and poor in 1. Complications such as neurological deficits, or superficial or deep wound infections did not develop. A recurrence of the fistula or pseudomeningocele after the treatment was not seen in any of our patients.
  
  
  CONCLUSIONS
  Pseudomeningoceles respond well to lumbar drainage, whereas over-sewing of the wound is an alternative treatment option in cerebrospinal fluid fistulas without neurological compromise.
authors.affiliation: Department of Orthopaedics and Traumatology, Kocaeli University School of Medicine, Izmit, Turkey.
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Tosun
authors.forename: Konuralp
authors.initials: K
authors.lastname: Ilbay
authors.forename: Michael Sun Min
authors.initials: MS
authors.lastname: Kim
authors.forename: Ozgur
authors.initials: O
authors.lastname: Selek