PSEUDOMENINGOCELE CSF FISTULA IN A PATIENT WITH LUMBAR SPINAL IMPLANTS TREATED WITH EPIDURAL BLOOD PATCH AND A BRIEF COURSE OF CLOSED SUBARACHNOID DRAINAGE - A CASE-REPORT/

Study Design. This case report illustrates the development of a cerebr ospinal fluid fistula and pseudomeningocele in a patient after lumbar discectomy and fusion with instrumentation. Objective. The patient is treated successfully with a combined treatment protocol of epidural bl ood patch and brief course of spinal drainage. Summary of Background D ata. Many surgeons advocate a trial of cerebrospinal fluid diversion f or postoperative cerebrospinal fluid fistula. This treatment may be pr oblematic in patients with spinal implants because a trial of cerebros pinal fluid diversion may not obliterate the extradural anatomic dead space that is created by instrumentation procedures and increases the risk of infection. A few case reports indicate that epidural blood pat ch also may be an effective management technique. A combined treatment protocol that may offer some advantages to either treatment alone is described. Methods. The patient was brought to the radiology departmen t, and a lumbar spinal drain was placed at the L2-L3 interspace under fluoroscopic guidance with the patient in the prone position. A Tuohy needle was inserted into the pseudomeningocele, and the collection was drained. Thirty milliliters of blood drawn from an antecubital vein w as injected into the epidural space over the laminectomy site. Spinal drainage was continued for 4 days. Results. The treatment protocol res ulted in resolution of cerebrospinal fluid leakage in the patient. Thi s result was confirmed by myelogram. Conclusions. Postoperative pseudo meningocele and cerebrospinal fluid fistula in patients with spinal in strumentation can be treated successfully with epidural blood patch an d a brief course (4 days) of spinal drainage. This combined treatment protocol may have some advantages to treatment with 7 days of cerebros pinal fluid diversion or to percutaneous epidural blood patch alone.