0
Articles   |    
Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine
SH Kitchel; FJ Eismont; BA Green
J Bone Joint Surg Am, 1989 Aug 01;71(7):984-987
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

A retrospective review was conducted to assess the effectiveness and safety of a temporary subarachnoid shunt to treat patients who have a leak of cerebrospinal fluid after a spinal operation. The shunt is percutaneously inserted in the lumbar spine and is removed after four days. This technique was used in nineteen patients over a ten-year period. Of the seventeen patients who had the shunt in place for the full four days, fourteen had resolution of the drainage of cerebrospinal fluid from the wound. One of two patients whose shunt was removed early also had a successful result. Eleven of the fifteen patients who were successfully treated were available for follow-up, and none had any adverse effects related to the original cerebrospinal-fluid leak or its treatment. The four patients who had a persistent leak were successfully treated with reoperation and direct repair of the dura. Eleven (58 per cent) of the nineteen patients had transient complaints of nausea and vomiting while being treated with subarachnoid drainage. Two of the nineteen patients had evidence of an intradural infection after placement of the catheter; the infection resolved in both patients after removal of the catheter and treatment with appropriate antibiotics. Closed subarachnoid drainage, when properly performed and monitored, is a reasonably effective and safe method for treating dural-cutaneous cerebrospinal-fluid leaks after a spinal operation. It may be considered as a non-operative alternative to the standard procedure of reoperation and direct repair of the dura. A good result is still possible in patients in whom this technique fails and who eventually need surgical management.

Figures in this Article
    This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    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.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    11/15/2013
    Louisiana - Ochsner Health System
    05/03/2012
    California - UCLA/OH Department of Orthopaedic Surgery
    01/22/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    12/31/2013
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina