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

Evolving Technique: “Drip, Drip! The CSF Leak in Anterior Spine Surgery” Arthur L. Jenkins, III MD FACS Founder, Jenkins NeuroSpine

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

Sutures Dura Spinal Cord

Thank you! • JenkinsNeuroSpine.com • ArthurJenkinsMD.com