Prevention and treatment of cerebrospinal fluid leakage in anterior cervical surgery for severe ossification of posterior longitudinal ligament
10.3760/cma.j.issn.0253-2352.2012.10.013
- VernacularTitle:颈椎严重后纵韧带骨化症前路手术脑脊液漏的预防和处理
- Author:
Tao LEI
;
Linfeng WANG
;
Yong SHEN
;
Junming CAO
;
Wenyuan DING
;
Qinghua MA
- Publication Type:Journal Article
- Keywords:
Cervical vertebrae;
Subdural effusion;
Postoperative complications
- From:
Chinese Journal of Orthopaedics
2012;32(10):962-967
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate prevention and treatment of cerebrospinal fluid leakage (CSFL)in anterior cervical spine surgery for severe ossification of posterior longitudinal ligament (OPLL).Methods A retrospective analysis of 47 patients with severe cervical OPLL (thickness of the ossified mass ＞ 5 mm,spinal stenosis ＞50％),who had undergone anterior cervical surgery between January 2008 and May 2011,was conducted.Fifteen cases of dural defect were found intraoperatively,including 11 males and 4 females,aged from 40 to 68 years (average,55.6 years).Preoperative CT scans were earefully analyzed.During the operation,the ossified mass was excised or floated and the arachnoid was reserved in order to reduce dural damage.Dural defects were repaired by suturing or covering with muscle.After surgery,patients were confined to bed rest to allow for drainage or puncture.Results All 15 patients were followed up for 12 to 18months (average,14.8 months).After operation,10 patients recovered fully without CSFL.Five patients developed CSFL,including 4 cases of spinal dural mater injury that healed within 4-6 days with bed rest and pressure dressing,and 1 case of cerebrospinal fluid pseudocyst that disappeared within 3 weeks with repeat puncture and aspiration treatment.No cases required secondary operations or shunt placement.All cases exhibited good neurological improvement.Conclusion During anterior surgical treatment for severe cervical OPLL,CSFL can be effectively prevented through eareful analysis of preoperative CT images,meticulous operative technique,reasonable handling of the ossified mass and positive repair of dural damage.Moreover,postoperative bed rest and drainage are effective to treat CSFL.
