EXPERIENCE IN MANAGEMENT OF OCCULT CEREBROSPINAL FLUID LEAKAGE IN POSTERIOR THORACOLUMBAR SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIXiaolong ¹ , XULian ¹ ,  KONGQingquan ¹ , YANGJin ^1,2 , SONGYueming ¹ , LITao ¹ , LIULimin ¹ , GONGQuan ¹ , ZENGJiancheng ¹ , LIUHao ¹

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopaedics, Affiliated Hospital of Luzhou Medical College;

Corresponding author：

KONGQingquan, Email: kongspine@126.com

Keywords：

Occult cerebrospinal fluid leakage; Posterior thoracolumbar surgery; Drainage

DOI：

10.7507/1002-1892.20150124

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the experience in management of occult cerebrospinal fluid leakage (CSFL) in posterior thoracolumbar surgeries, and to explore the best drainage duration, as well as to analyse the ways to reduce the risk of CSFL. Methods A retrospective analysis was made on the clinical data of 26 patients with occult CSFL in posterior thoracolumbar surgeries between January 2011 and January 2013. There were 15 males and 11 females, with the average age of 48.7 years (range, 36-59 years). Headache occurred in 19 cases, and 5 cases had nausea with 3 cases also having vomiting after operation. Drainage tube unobstructed and no CSFL from the skin incision were observed in 23 cases at the postoperative 2nd day, and the drainage pipe clamp test was performed at the 3rd day. Twenty-one patients had no CSFL and were given extubation; 2 cases having CSFL were given extubation after conservative treatments for 10 days. Three patients had CSFL with ineffective conservative treatments at the postoperative 2nd day, then received reoperation, incision suture, and drainage. At the postoperative 3rd day, if no CSFL was observed, these patients were given extubation and stayed in bed for 3-5 days. Results All incisions healed and the healing time was 7-15 days (mean, 8 days). No incision infection, persistent CSFL, and other complications occurred. After extubation, headache, nausea, vomiting, and other symptoms were alleviated immediately. All patients were followed up 12-24 months (mean, 16 months). MRI at the postoperative 6th month showed no subcutaneous epidural pseudocyst. Conclusion The quality of suturing is the key factor to prevent occult CSFL in posterior thoracolumbar surgery. Under the premise of good suture quality, extubation can be given at the postoperative 3rd day. Before extubation, the drainage pipe clamp test can be performed to make sure no CSFL and to reduce the risk of CSFL from the surgical incision after extubation.

Citation： LIXiaolong, XULian, KONGQingquan, YANGJin, SONGYueming, LITao, LIULimin, GONGQuan, ZENGJiancheng, LIUHao. EXPERIENCE IN MANAGEMENT OF OCCULT CEREBROSPINAL FLUID LEAKAGE IN POSTERIOR THORACOLUMBAR SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(5): 572-575. doi: 10.7507/1002-1892.20150124 Copy

1.	Guerin P, EI Fegoun AB, Obeid I, et al. Incidental durotomy during spine surgery:incidence, management and complications. A retrospective review. Injury, 2012, 43(4):397-401.
2.	Strömqvist F, Jönsson B, Strömqvist B, et al. Dural lesions in lumbar disc herniation surgery:incidence, risk factors, and outcome. Eur Spine J, 2010, 19(3):439-442.
3.	Lotfinia I, Sayyahmelli S. Incidental durotomy during lumbar spine surgery. Neurosurgery Quarterly, 2012, 22(2):105-112.
4.	Joseph V, Kumar GS, Rajshekhar V. Cerebrospinal fluid leak during cervical corpectomy for ossified posterior longitudinal ligament:incidence, management, and outcome. Spine (Phila Pa 1976), 2009, 34(5):491-494.
5.	Raffa SJ, Benglis DM, Levi AD. Treatment of a persistent iatrogenic cerebrospinal fluid-pleural fistula with a cadaveric dural-pleural graft. Spine J, 2009, 9(4):e25-e29.
6.	Bachmann G, Djenabi U, Jungehülsing M, et al. Incidence of occult cerebrospinal fluid fistula during paranasal sinus surgery. Arch Otolaryngol Head Neck Surg, 2002, 128(11):1299-1302.
7.	Cho JY, Chan CK, Lee SH, et al. Management of cerebrospinal fluid leakage after anterior decompression for ossification of posterior longitudinal ligament in the thoracic spine:the utilization of a volume-controlled pseudomeningocele. J Spinal Disord Tech, 2012, 25(4):E93-E102.
8.	Washburn EW. The dynamics of capillary flow. Physical Review, 1921, 17(3):273-283.
9.	Pirofsky B. The determination of blood viscosity in man by a method based on Poiseuille's law. J Clin Invest, 1953, 32(4):292-298.
10.	Volobuev AN, Tolstonogov AP. Features of viscous-fluid flow in an elastic pipeline. Journal of Engineering Physics and Thermophysics, 2009, 82(4):749-755.
11.	Srivastava A, Sood A, Joy SP, et al. Principles of physics in surgery:the laws of flow dynamics physics for surgeons-Part 1. Indian J Surg, 2009, 71(4):182-187.
12.	Reddick AD, Ronald J, Morrison WG. Intravenous fluid resuscitation:was Poiseuille right? Emerg Med J, 2011, 28(3):201-202.
13.	McPherson D, Adekanye O, Wilkes AR, et al. Fluid flow through intravenous cannulae in a clinical model. Anesth Analg, 2009, 108(4):1198-1202.
14.	Song D, Park P. Primary closure of inadvertent durotomies utilizing the U-Clip in minimally invasive spinal surgery. Spine (Phila Pa 1976), 2011, 36(26):E1753-E1757.
15.	Clendenen SR, Pirris S, Robards CB, et al. Symptomatic postlaminectomy cerebrospinal fluid leak treated with 4-dimensional ultrasound-guided epidural blood patch. J Neurosurg Anesthesiol, 2012, 24(3):222-225.
16.	Tosun B, Ilbay K, Kim MS, et al. Management of persistent cerebrospinal fluid leakage following thoraco-lumbar surgery. Asian Spine J, 2012, 6(3):157-162.
17.	Tafazal SI, Sell PJ. Incidental durotomy in lumbar spine surgery:incidence and management. Eur Spine J, 2005, 14(3):287-290.
18.	Hawk MW, Kim KD. Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus, 2000, 9(1):e5.
19.	Shapiro SA, Scully T. Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. Neurosurgery, 1992, 30(2):241-245.
20.	Kitchel SH, Eismont FJ, Green BA. Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg (Am), 1989, 71(7):984-987.

1. Guerin P, EI Fegoun AB, Obeid I, et al. Incidental durotomy during spine surgery:incidence, management and complications. A retrospective review. Injury, 2012, 43(4):397-401.
2. Strömqvist F, Jönsson B, Strömqvist B, et al. Dural lesions in lumbar disc herniation surgery:incidence, risk factors, and outcome. Eur Spine J, 2010, 19(3):439-442.
3. Lotfinia I, Sayyahmelli S. Incidental durotomy during lumbar spine surgery. Neurosurgery Quarterly, 2012, 22(2):105-112.
4. Joseph V, Kumar GS, Rajshekhar V. Cerebrospinal fluid leak during cervical corpectomy for ossified posterior longitudinal ligament:incidence, management, and outcome. Spine (Phila Pa 1976), 2009, 34(5):491-494.
5. Raffa SJ, Benglis DM, Levi AD. Treatment of a persistent iatrogenic cerebrospinal fluid-pleural fistula with a cadaveric dural-pleural graft. Spine J, 2009, 9(4):e25-e29.
6. Bachmann G, Djenabi U, Jungehülsing M, et al. Incidence of occult cerebrospinal fluid fistula during paranasal sinus surgery. Arch Otolaryngol Head Neck Surg, 2002, 128(11):1299-1302.
7. Cho JY, Chan CK, Lee SH, et al. Management of cerebrospinal fluid leakage after anterior decompression for ossification of posterior longitudinal ligament in the thoracic spine:the utilization of a volume-controlled pseudomeningocele. J Spinal Disord Tech, 2012, 25(4):E93-E102.
8. Washburn EW. The dynamics of capillary flow. Physical Review, 1921, 17(3):273-283.
9. Pirofsky B. The determination of blood viscosity in man by a method based on Poiseuille's law. J Clin Invest, 1953, 32(4):292-298.
10. Volobuev AN, Tolstonogov AP. Features of viscous-fluid flow in an elastic pipeline. Journal of Engineering Physics and Thermophysics, 2009, 82(4):749-755.
11. Srivastava A, Sood A, Joy SP, et al. Principles of physics in surgery:the laws of flow dynamics physics for surgeons-Part 1. Indian J Surg, 2009, 71(4):182-187.
12. Reddick AD, Ronald J, Morrison WG. Intravenous fluid resuscitation:was Poiseuille right? Emerg Med J, 2011, 28(3):201-202.
13. McPherson D, Adekanye O, Wilkes AR, et al. Fluid flow through intravenous cannulae in a clinical model. Anesth Analg, 2009, 108(4):1198-1202.
14. Song D, Park P. Primary closure of inadvertent durotomies utilizing the U-Clip in minimally invasive spinal surgery. Spine (Phila Pa 1976), 2011, 36(26):E1753-E1757.
15. Clendenen SR, Pirris S, Robards CB, et al. Symptomatic postlaminectomy cerebrospinal fluid leak treated with 4-dimensional ultrasound-guided epidural blood patch. J Neurosurg Anesthesiol, 2012, 24(3):222-225.
16. Tosun B, Ilbay K, Kim MS, et al. Management of persistent cerebrospinal fluid leakage following thoraco-lumbar surgery. Asian Spine J, 2012, 6(3):157-162.
17. Tafazal SI, Sell PJ. Incidental durotomy in lumbar spine surgery:incidence and management. Eur Spine J, 2005, 14(3):287-290.
18. Hawk MW, Kim KD. Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus, 2000, 9(1):e5.
19. Shapiro SA, Scully T. Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. Neurosurgery, 1992, 30(2):241-245.
20. Kitchel SH, Eismont FJ, Green BA. Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg (Am), 1989, 71(7):984-987.

Previous Article
EFFECTIVENESS OF A NEW ALLOGRAFT BONE IN APPLICATION OF ANTERIOR CERVICAL OPERATION
Next Article
EXPRESSION OF Sonic Hedgehog SIGNALING PATHWAY AFTER SPINAL CORD INJURY IN ADULT RATS

Chinese Journal of Reparative and Reconstructive Surgery

EXPERIENCE IN MANAGEMENT OF OCCULT CEREBROSPINAL FLUID LEAKAGE IN POSTERIOR THORACOLUMBAR SURGERY

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content