Huang Yan-Sheng, Zhang Hai-Ping, Niu Xing-Bang, Shi Shao-Yan, Hao Ding-Jun
Department of Spinal Surgery, the Red Cross Hospital Affiliated to College of Medicine of Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China;
Zhongguo Gu Shang. 2017 Sep 25;30(9):853-856. doi: 10.3969/j.issn.1003-0034.2017.09.014.
To analyze the causes and explore the measures of prevention and treatment of the cerebrospinal leak after lumbar revision surgery.
The clinical data of 24 patients(17.78%) with cerebrospinal leak among 135 cases after lumbar revision surgery from January 2011 to January 2016 was retrospectively studied. Of them, 12 cases due to severe adhesion caused by scar formation; 4 cases due to yellow ligament hyperplasia adhesion with dura mater occurred dural tears when separating adhesion; 2 cases with severe hyperplasia and ossification of lumbar posterior longitudinal ligament occurred dural tears when revealing intervertebral disk; 2 cases due to improper nailing happened dural tears during operation. And the other 4 cases without obvious dural tears in surgery, occurred cerebrospinal leak one to two days after surgery. And the 24 patients were treated with the measures of prevention and treatment preoperatively, intraoperatively, and postoperatively.
Twenty-four patients with cerebrospinal leak were cured after treatment and were follow-up for 6 to 30 months. No recurrence of cerebrospinal leake or local and systemic complications were found.
Scar formation is the main cause of cerebrospinal leak in lumbar revision surgery. As for lumbar revision surgery, as long as the standard control measures are taken, it can significantly reduce the incidence of cerebrospinal leak, achieve better clinical efficacy, and fundamentally solve the cerebrospinal leak problem that has plagued both doctors and patients for a long time.
分析腰椎翻修术后脑脊液漏的原因，探讨其防治措施。
回顾性研究2011年1月至2016年1月135例腰椎翻修术后24例（17.78%）发生脑脊液漏患者的临床资料。其中，12例因瘢痕形成导致严重粘连；4例因黄韧带增生粘连硬脑膜，分离粘连时发生硬脑膜撕裂；2例腰椎后纵韧带严重增生骨化，显露椎间盘时发生硬脑膜撕裂；2例因置钉不当术中发生硬脑膜撕裂。另外4例手术中无明显硬脑膜撕裂，术后1至2天发生脑脊液漏。对24例患者采取术前、术中、术后防治措施。
24例脑脊液漏患者经治疗后均治愈，随访6至30个月，无脑脊液漏复发及局部和全身并发症发生。
瘢痕形成是腰椎翻修术后脑脊液漏的主要原因。对于腰椎翻修手术，只要采取规范的防治措施，可显著降低脑脊液漏的发生率，取得较好的临床疗效，从根本上解决长期困扰医患双方的脑脊液漏问题。
