Cerebrospinal Fluid Leak During Cervical Corpectomy for Ossified Posterior Longitudinal Ligament

Joseph, Vivek; Kumar, G Samson Sujit; Rajshekhar, Vedantam

doi:10.1097/brs.0b013e318195d245

Cited by 66 publications

(56 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…38 Choi et al 12 reported on a series of 47 patients who underwent corpectomy for OPLL, 2 of whom developed a CSF leak intraoperatively; both of these patients underwent primary repair with either a fat or a fascial graft augmented with fibrin sealant followed by immediate placement of a lumbar drain in the recovery room. Similarly, Min et al 42 reported successful resolution using lumbar drainage and bed rest of 6 intraoperative CSF leaks among 19 patients who underwent ventral surgery for OPLL, and Joseph et al 33 described successful resolution of 9 intraoperative CSF leaks in 144 patients. All 9 in the latter series were treated with a fascia graft, Gelfoam, and immediate placement of a lumbar drain that remained in place for 5 days.…”

Section: Intraoperative Strategiesmentioning

confidence: 99%

“…4,9,16,21,22,25,26,28,36,55 For OPLL, the incidence is much higher, ranging from 4.3% to 32%. 1,3,11,12,17,27,33,42,43,52 In a review of 1994 cases, Hannallah et al 26 reported that the presence of OPLL was the greatest risk factor for the development of a CSF leak after anterior decompression surgery and that patients with OPLL were 13.7 times more likely to have a leak than were patients without this condition.…”

Section: Incidencementioning

confidence: 99%

See 1 more Smart Citation

Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Mazur¹,

Jost²,

Schmidt³

et al. 2011

FOC

View full text Add to dashboard Cite

Object Anterior decompression is an effective way to treat cervical myelopathy associated with ossification of the posterior longitudinal ligament (OPLL); however, this approach is associated with an increased risk of a dural tear and resultant CSF leak because fusion of the dura with the ossified PLL is common in these cases. The authors review the literature and present an algorithm for treatment of CSF leaks in these patients. Methods A MEDLINE review was performed to identify papers related to CSF leak after anterior decompression for OPLL, and data were summarized to identify treatment options for various situations. A treatment algorithm was identified based on these findings and the experience of the authors. Results Eleven studies were identified that presented data on intra- and postoperative management of a CSF leak during ventral surgery for OPLL. The incidence of cervical dural tears and CSF leaks after anterior decompression procedures for OPLL ranged from 4.3% to 32%. Techniques including preventative measures, intraoperative dural repair with various materials, and postoperative drainage or shunt placement have all been used. Conclusions Although direct dural repair is the preferred treatment for CSF leak, this technique is not always technically possible. In these cases, intraoperative adjuncts in combination with postoperative measures can be used to decrease the pressure gradient across the dural tear.

show abstract

Section: Intraoperative Strategiesmentioning

confidence: 99%

Section: Incidencementioning

confidence: 99%

Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Mazur¹,

Jost²,

Schmidt³

et al. 2011

FOC

View full text Add to dashboard Cite

show abstract

“…5,13,23,34 Although it is more intuitive to decompress the spinal cord anteriorly, at the origin of the OPLL mass effect, complications like CSF leaks are not uncommon. 1,2,7,14,36 Posterior approaches allow for expansion of the spinal canal and indirect decompression of multiple segments. Therefore, surgical treatment should be tailored according to each patient's condition and each surgeon's level of confidence with a particular technique.…”

Section: Discussionmentioning

confidence: 99%

Laminoplasty outcomes: is there a difference between patients with degenerative stenosis and those with ossification of the posterior longitudinal ligament?

Meyer

Mummaneni

2011

FOC

View full text Add to dashboard Cite

Object Two common causes of cervical myelopathy include degenerative stenosis and ossification of the posterior longitudinal ligament (OPLL). It has been postulated that patients with OPLL have more complications and worse outcomes than those with degenerative stenosis. The authors sought to compare the surgical results of laminoplasty in the treatment of cervical stenosis with myelopathy due to either degenerative changes or segmental OPLL. Methods The authors conducted a retrospective review of 40 instrumented laminoplasty cases performed at a single institution over a 4-year period to treat cervical myelopathy without kyphosis. Twelve of these patients had degenerative cervical stenotic myelopathy ([CSM]; degenerative group), and the remaining 28 had segmental OPLL (OPLL group). The 2 groups had statistically similar demographic characteristics and number of treated levels (mean 3.9 surgically treated levels; p > 0.05). The authors collected perioperative and follow-up data, including radiographic results. Results The overall clinical follow-up rate was 88%, and the mean clinical follow-up duration was 16.4 months. The mean radiographic follow-up rate was 83%, and the mean length of radiographic follow-up was 9.3 months. There were no significant differences in the estimated blood loss (EBL) or length of hospital stay (LOS) between the groups (p > 0.05). The mean EBL and LOS for the degenerative group were 206 ml and 3.7 days, respectively. The mean EBL and LOS for the OPLL group were 155 ml and 4 days, respectively. There was a statistically significant improvement of more than one grade in the Nurick score for both groups following surgery (p < 0.05). The Nurick score improvement was not statistically different between the groups (p > 0.05). The visual analog scale (VAS) neck pain scores were similar between groups pre- and postoperatively (p > 0.05). The complication rates were not statistically different between groups either (p > 0.05). Radiographically, both groups lost extension range of motion (ROM) following laminoplasty, but this change was not statistically significant (p > 0.05). Conclusions Patients with CSM due to either degenerative disease or segmental OPLL have similar perioperative results and neurological outcomes with laminoplasty. The VAS neck pain scores did not improve significantly with laminoplasty for either group. Laminoplasty may limit extension ROM.

show abstract

“…1,8,23,63,64 Our results indicate that OPLL and skip CC are important risk factors for dural tear following CC. Our experience in managing CSF leak following CC for OPLL was the subject of a previous publication, 27 which also demonstrated that intraoperative repair followed by postoperative lumbar subarachnoid drainage could obviate the need for revision surgery in most patients. Dural tears following CC for CSM were also managed successfully with the same strategy.…”

Section: Dural Tearmentioning

confidence: 99%

“…In all cases, a lumbar subarachnoid drain was inserted postoperatively, followed by restricted ambulation for 5-7 days. 27 No patient with dural tears developed meningitis, pseudomeningocele, or CSF fistula, and none required reoperation for dural repair. Recurrent laryngeal nerve injuries occurred in 2 patients who developed vocal hoarseness postoperatively.…”

Section: Complicationsmentioning

confidence: 99%

Complications following central corpectomy in 468 consecutive patients with degenerative cervical spine disease

Sarkar¹,

Nair²,

Rajshekhar³

2016

FOC

Self Cite

View full text Add to dashboard Cite

OBJECTIVE This study was performed to describe the incidence and predictors of perioperative complications following central corpectomy (CC) in 468 consecutive patients with cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL). METHODS The authors performed a retrospective review of a cohort of patients who had undergone surgery for CSM (n = 338) or OPLL (n = 130) performed by a single surgeon over a 15-year period. All patients underwent uninstrumented CC with autologous iliac crest or fibular strut grafting. Preoperative clinical and imaging details were collected, and the type and incidence of complications were studied. Univariate and multivariate analyses were performed to establish risk factors for the development of perioperative complications. RESULTS Overall, 12.4% of patients suffered at least 1 complication following CC. The incidence of major complications was as follows: C-5 radiculopathy, 1.3%; recurrent laryngeal nerve injury, 0.4%; dysphagia, 0.8%; surgical-site infection, 3.4%; and dural tear, 4.3%. There was 1 postoperative death (0.2%). On multivariate analysis, patients in whom the corpectomy involved the C-4 vertebral body (alone or as part of multilevel CC) were significantly more likely to suffer complications (p = 0.004). OPLL and skip corpectomy were risk factors for dural tear (p = 0.015 and p = 0.001, respectively). No factors were found to be significantly associated with postoperative C-5 palsy, dysphagia, or acute graft extrusion on univariate or multivariate analysis. Patients who underwent multilevel CC were predisposed to surgical-site infections, with a slight trend toward statistical significance (p = 0.094). The occurrence of a complication after surgery significantly increased the mean duration of postoperative hospital stay from 5.0 ± 2.3 days to 8.9 ± 6 days (p < 0.001). CONCLUSIONS Complications following CC for CSM or OPLL are infrequent, but they significantly prolong hospital stay. The most frequent complication following CC is dural tear, for which a diagnosis of OPLL and a skip corpectomy are significant risk factors.

show abstract

Cerebrospinal Fluid Leak During Cervical Corpectomy for Ossified Posterior Longitudinal Ligament

Abstract: Intraoperative CSF leak was encountered in 6.3% of patients undergoing CC for OPLL. A successful repair was achieved using fascial graft, gelatin sponge, lumbar CSF drainage, and bed rest.

Cited by 66 publications

References 20 publications

Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Laminoplasty outcomes: is there a difference between patients with degenerative stenosis and those with ossification of the posterior longitudinal ligament?

Complications following central corpectomy in 468 consecutive patients with degenerative cervical spine disease

Contact Info

Product

Resources

About