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Anterior approach, additional drains preoperatively may mitigate cerebrospinal fluid leaks

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Daniel K. Resnick

CHICAGO — Spine surgeons may be able to mitigate some dural tears and subsequent cerebrospinal fluid leaks by taking steps preoperatively and intraoperatively to prevent and manage these complications, a presenter at the North American Spine Society Annual Meeting said.

According to Daniel K. Resnick, MD, MS, anticipating a dural tear and being aware of options to treat it, as well as a cerebrospinal fluid (CSF) leak, are critical to avoiding and managing these spine surgery complications.

“Prepare preoperative[ly] for a dural tear. Prep the thigh to have facia lata available and have appropriate sutures [for the dura] available,” Resnick said during a symposium on spine surgery complications avoidance and management strategies.

Creating a vascularized pleural flap on exposure is a practice Resnick said may avoid or mitigate the need for taking fascia lata.

He also discussed being prepared by identifying prior to surgery what may prove to be a difficult case. Patient factors, such as older age or the presence of a calcified disc or ossified posterior longitudinal ligament, can increase the risk of dural tears and CSF leaks, Resnick said.

“I am better at ordering preoperative CT scans to check where the site of a calcification is,” he said.

Also, Resnick typically prefers to treat patients undergoing cervical spine surgery from the front because he said that approach tends to help avoid CSF leaks.

“I am more likely to go posterior when more than two levels are involved” and when treating older patients, he said.

“Lessons? Anticipate the leak, adding a drain beforehand,” Resnick said, noting that proactively adding a drain is easier than trying to add a cervical or lumbar drain after a CSF leak occurs. – by Susan M. Rapp

Reference:

Resnick DK. CSF leaks: How to avoid and best management strategies. Presented at: North American Spine Society Annual Meeting; Sept. 25-28, 2019; Chicago.

Disclosure: Resnick reports no relevant financial disclosures.