Evolving Technique: Drip, Drip! The CSF Leak in Anterior Spine - - PowerPoint PPT Presentation

Arthur L. Jenkins, III MD FACS Founder, Jenkins NeuroSpine

Evolving Technique: “Drip, Drip! The CSF Leak in Anterior Spine Surgery”

Disclosures:

• None, other than….
• I get paid to fix spinal fluid leaks
• ”Dr. Dura”
• 180 unintended durotomy repairs plus

another 100 or so intended durotomy (ie, primary intradural) repairs

Dural repairs necessary whenever

• Exposure not adequate to manage

adhesions

• Friable or ectatic dura
• Other Host factors
• Other Iatrogenic factors
• 🙉😲🤰💪

Patient host factors lead to difficulties and increasing complexity of repair

• Healing/immune suppression
• Chronic Steroids
• RA and treatments
• Radiation
• Electrocution
• Conduction pathway, meninges get

fried...

Complications of untreated CSF leak

• Headaches and downwards herniation of

brain

• Fluid accumulation and mass effect
• Aseptic or septic meningitis
• Superficial siderosis
• Arachnoiditis, tethering, “herniation

syndrome”

Principles of Repair

• You can ALMOST always get clean edges to

close

• Always close if you can, covering up with

glue only works some of the time

• Use a patch or buttress where possible
• Closed to Valsalva usually holds

To Drain or not to Drain?

• That is the question!
• Two types of drains:

– Lumbar drain – Deep drain (outside spine)

180 cases of unintended durotomy repair

• None in the last 8-10 years with a lumbar

drain

• Almost all had some deep extraspinal

drain

– If CSF leaking into that drain, then drain up to 5 days then pull drain (close dead space) – If highly complex then bilateral repair – Inside and outside layer to prevent leakage at suture line – Only 2 that didn’t hold after primary repair: – Previously radiated, and responded to bilateral repair

Spinal Cord Dura Sutures

Thank you!

• JenkinsNeuroSpine.com
• ArthurJenkinsMD.com