Management and outcome of cerebrospinal fluid leakage during anterior cervical fusion for an ossified posterior longitudinal ligament

Kuang-Ting Yeh^{a, b}, Ing-Ho Chen^{a, c}, Tzai-Chiu Yu^{a, c}, Cheng-Huan Peng^a, Kuan-Lin Liu^a, Wen-Tien Wu^{a, c}

^a Department of Orthopedics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
^c School of Medicine, Tzu Chi University, Hualien, Taiwan

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Abstract
The rate of dural tears during anterior cervical diskectomy or corpectomy with fusion is higher in those patients with ossified posterior longitudinal ligaments (OPLL) than with those with other causes of cervical spinal stenosis. Various techniques have been described to deal with dural tears with cerebrospinal fluid (CSF) leakage in OPLL. Dural repair accompanied by a shunting technique with a lumbar subarachnoid drain is most commonly used. However, overdrainage of CSF fluid can cause further complications. Monitoring to keep the lumbar drain from overdrainage has not been described well in previous reports. In our series, 50 patients diagnosed with OPLL underwent anterior cervical surgery between July 2005 and June 2012. Dural tears with CSF leakage occurred in three patients. The dural defects were all about 1 mm in length. The dural defect was covered with a blood clot and gelfoam sponge. A closed suction drain (Hemovac) was placed as usual. After completion of the cervical surgery, a lumbar subarachnoid drain was inserted. The purpose of the lumbar drain was to shunt CSF pressure and avoid CSF leakage at the tear site. The lumbar drain rate was set at <20 mL/hour to prevent further complications. The effects of the lumbar drain were monitored and the drain rate was decreased gradually by observing the amount of cervical closed drainage, which should be minimal. The lumbar drains were used for 7 days in these three cases. There were no infections, severe headaches, or any other CSF leakage-related complications. None of the patients required reoperation for CSF leakage. Using a blood clot and gelfoam sponge to cover a dural tear site and placing a distant lumbar drain to shunt CSF pressure is an effective and successful method to treat CSF leakage in cervical operations.

Keywords
Anterior cervical corpectomy with fusion; Anterior cervical diskectomy with fusion; Cerebrospinal fluid leakage; Lumbar drain; Ossified posterior longitudinal ligaments