title: Cerebrospinal fluid leaks and their management after anterior cervical discectomy and fusion: a report of 13 cases and a review of the literature.
abstract: METHODS
  Retrospective medical record review and literature review.
  
  
  OBJECTIVE
  To identify cases where a cerebrospinal fluid (CSF) leak occurred during an anterior cervical discectomy and fusion (ACDF) and to create a management algorithm based on the findings.
  
  
  BACKGROUND
  ACDF is a commonly performed spinal operation. It is effective with very low complication rates. One rare complication of ACDF is a CSF leak. There is limited information on the management of CSF leaks after ACDF and management is on a surgeon-by-surgeon basis.
  
  
  METHODS
  We reviewed 3 surgeons' case logs and identified cases where a CSF leak was encountered during ACDF and reviewed the patients' medical records, operative reports and imaging to determine how these leaks were managed. We also performed a PubMed search for articles about the presentation and management of CSF leaks after ACDF.
  
  
  RESULTS
  Thirteen CSF leaks were identified in 1223 ACDFs, corresponding to a CSF leak rate of 1%. Of these, 9 were successfully treated with intraoperative repair. Postoperative lumbar drainage was used in the remaining 4 patients and was successful in 1 patient. Three patients underwent neck re-exploration and attempted delayed repair. Three patients, including one who was found to have hydrocephalus, ultimately required continuous CSF diversion via shunting. We identified 7 case reports of CSF leak in ADCF in the literature and 1 article that reviewed the prevalence and management of this complication.
  
  
  CONCLUSIONS
  CSF leak after ACDF is an uncommon complication that can usually be repaired. We provide a stepwise management strategy for CSF leaks in ACDF.
authors.affiliation: From the Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania Hospital, Philadelphia, PA.
authors.forename: Peter
authors.initials: P
authors.lastname: Syre
authors.forename: Leif-Erik
authors.initials: LE
authors.lastname: Bohman
authors.forename: Gordon
authors.initials: G
authors.lastname: Baltuch
authors.forename: Peter
authors.initials: P
authors.lastname: Le Roux
authors.forename: William C
authors.initials: WC
authors.lastname: Welch
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome