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KMID : 0360720130260030151
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Journal of the Korean Society Traumatology
2013 Volume.26 No. 3 p.151 ~ p.156
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Management of Cerebrospinal Fluid Leak after Traumatic Cervical Spinal Cord Injury
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Lee Soo-Eon
Chung Chun-Kee
Jahng Tae-Ahn
Kim Chi-Heon
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Abstract
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Purpose: Traumatic cervical SCI is frequently accompanied by dural tear and the resulting cerebrospinal fluid (CSF) leak after surgery can be troublesome and delay rehabilitation with increasing morbidity. This study evaluated the incidence of intraoperative CSF leaks in patients with traumatic cervical spinal cord injury (SCI) who underwent anterior cervical surgery and described the reliable management of CSF leaks during the perioperative period.
Methods: A retrospective study of medical records and radiological images was done on patients with CSF leaks after cervical spine trauma.
Results: Seven patients(13.2%) were identified with CSF leaks during the intraoperative period. All patients were severely injured and showed structural abnormalities on the initial magnetic resonance image (MRI) of the cervical spine. Intraoperatively, no primary repair of dural tear was attempted because of a wide, rough defect size. Therefore, fibrin glue was applied to the operated site in all cases. Although a wound drainage was inserted, it was stopped within the first 24 hours after the operation. No lumbar drainage was performed. Postoperatively, the patients should kept their heads in an elevated position and early ambulation and rehabilitation were encouraged. None of the patients developed complications related to CSF leaks during admission.
Conclusion: The incidence of CSF leaks after surgery for cervical spinal trauma is relatively higher than that of cervical spinal stenosis. Therefore, one should expect the possibility of a dural tear and have a simple and effective management protocol for CSF leaks in trauma cases established.
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KEYWORD
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Spine trauma, Cerebrospinal leakage, Dura tear, Cervical spine
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