Management of cerebrospinal fluid leak following surgery in posttraumatic cervical spinal cord injury

Abstract

Background: Anterior cervical discectomy with fusion is a commonly performed procedure for symptomatic cervical disc herniation. However, Cerebrospinal fluid (CSF) leak is a rare complication accounting for about 0.2–3% and there is no definitive management algorithm for the management of the same.Case description: We report, case of a 32 year old quadriplegic gentleman with C3–C4 level traumatic disc prolapse with cord contusion and edema following road traffic accident. He developed incidental durotomy with significant CSF leak during ACDF surgery. It was managed successfully using a small rolled piece of surgicel, acetazolamide and lumbar drain. He has been on regular follow up and at 10 months postoperatively, there is no CSF related complication with Karnofsky Performance score of 90. Conclusion: Our treatment approach provides a viable option of managing CSF leak in low to medium income countries or in situations where ready access to fibrin glue or tacho sealant is not possible. In case of traumatic disc prolapse with cord contusion, it reduces the chances of mass effect, infection, foreign body reaction and overall cost of surgery. In this case of traumatic disc prolapse, CSF leak had actually hastened recovery of neurological deficits.

Keywords

• Post traumatic cervical disc prolapse
• Spinal cord injury
• Anterior cervical discectomy with fusion (ACDF)
• CSF leak