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Cerebrospinal Fluid Leaks Following Cervical Spine Surgery
David Hannallah, MD, MS1; Joon Lee, MD1; Mustafa Khan, MD1; William F. Donaldson, MD1; James D. Kang, MD1
1 Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1010, Pittsburgh, PA 15213. E-mail address for D. Hannallah: hannallah@gmail.com
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 May 01;90(5):1101-1105. doi: 10.2106/JBJS.F.01114
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Background: A cerebrospinal fluid leak during cervical spine surgery is a feared complication. However, little is known about the prevalence, management, and long-term course of these events.

Methods: The medical records of 1994 patients who had elective cervical spine surgery during an eleven-year period (1994 through 2005) were reviewed. Patients with cervical cerebrospinal fluid leaks identified at the time of surgery were followed both clinically and radiographically for an average of 5.4 years postoperatively. The prevalence, etiology, management, and outcome of all of the cervical cerebrospinal fluid leaks were analyzed.

Results: The overall prevalence of cerebrospinal fluid leaks was 1%. The prevalence of cerebrospinal fluid leaks was higher in patients with a diagnosis of ossification of the posterior longitudinal ligament (12.5%), patients having a revision anterior procedure (1.92%), men (1.56%), and patients undergoing an anterior cervical corpectomy and arthrodesis (1.77%).

Conclusions: Many cervical dural tears can be managed by observation alone or by placement of a lumbar cerebrospinal fluid shunt either during the index procedure or in the postoperative period. At an average follow-up of 5.4 years, there were no long-term sequelae of the cervical dural tears in our series.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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