Management and outcomes of cerebrospinal fluid leakage after anterior resection of cervical ossification of posterior longitudinal ligament

English Keywords:Ossification of posterior longitudinal ligament  Cervical vertebrae  Dural  Cerebrospinal fluid leak

English Abstract:

  【Abstract】 Objectives: To analyze　and evaluate the management and outcomes of cerebrospinal fluid(CSF) leakage after anterior resection of　cervical ossification of　posterior longitudinal ligament(OPLL)．　Methods: A retrospective analysis was performed on 126 patients suffering from OPLL and undergoing anterior decompression between January 2008 and January 2012. Among the patients, there were 89 males and 37 females, with an average age of 61 years(range, 46-72 years) and an average course of 4.2 years(range, 3 days-7 years). The　length of ossification meassured in the sagittal plane involved 1-3 vertebrae. Eleven cases were associated with dural matter　ossification, and 7 of them had dural tears or defects. However, only 4 cases developed dural tears among the rest 115 patients. Gelatin sponge　coverage and　fibrin glue　sealing were used to repair the dura matter during operation. Bed rest, drainage, nutritional support and antibiotics administration were adopted after surgery. Results:　All 11 cases suffering from dural tears or defects developed CSF leakage after operation. The overall incidence of　CSF leakage was 8.7%(11/126), which showed significant difference comparing with dural　ossification(63.6%, 7/11) group and no ossification group(0.03%, 4/115)(P<0.001). Three cases had CSF leakage healed within 5 days after operation, while 8 cases evolved into intermittent　CSF cyst. Circular pressure bandage, repeated aspiration　and insertion of a lumbar drainage　were used. All 8 patients recovered 14　to 30 days later after operation. After an average follow-up of 12.8 months(range 1 to 36 months), the average improvement rate of JOA score was 51.2％, and no neurological deficit or persistent headache remained. Conclusions: OPLL is prone to develop dural injury during cervical anterior surgery, which leads to high incidence of　CSF leakage, variety interventions should be undertaken.