Syre Peter, Bohman Leif-Erik, Baltuch Gordon, Le Roux Peter, Welch William C
From the Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania Hospital, Philadelphia, PA.
Spine (Phila Pa 1976). 2014 Jul 15;39(16):E936-43. doi: 10.1097/BRS.0000000000000404.
Retrospective medical record review and literature review.
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.
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.
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.
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.
CSF leak after ACDF is an uncommon complication that can usually be repaired. We provide a stepwise management strategy for CSF leaks in ACDF.
回顾性病历审查与文献综述。
确定在前路颈椎间盘切除融合术（ACDF）期间发生脑脊液（CSF）漏的病例，并根据研究结果制定管理算法。
ACDF是一种常见的脊柱手术。它疗效显著，并发症发生率极低。ACDF的一种罕见并发症是脑脊液漏。关于ACDF后脑脊液漏的管理信息有限，且管理方式因外科医生而异。
我们查阅了3位外科医生的病例记录，确定了ACDF期间遇到脑脊液漏的病例，并查阅了患者的病历、手术报告和影像学资料，以确定这些漏液是如何处理的。我们还在PubMed上搜索了关于ACDF后脑脊液漏的表现和管理的文章。
在1223例ACDF手术中发现了13例脑脊液漏，脑脊液漏发生率为1%。其中，9例通过术中修复成功治疗。其余4例患者采用术后腰椎引流，1例成功。3例患者接受颈部再次探查并尝试延迟修复。3例患者，包括1例被发现患有脑积水的患者，最终需要通过分流进行持续脑脊液引流。我们在文献中确定了7例ACDF脑脊液漏的病例报告和1篇综述该并发症患病率和管理的文章。
ACDF后脑脊液漏是一种罕见的并发症，通常可以修复。我们提供了ACDF脑脊液漏的逐步管理策略。
