Anterior cervical micro-dural repair of cerebrospinal fluid fistula after surgery for ossification of the posterior longitudinal ligament - Technicalnote

BACKGROUND Cerebrospinal fluid (CSF) fistulas may occur during anterior cervical surge ry performed for the resection of ossification of the posterior longitudina l ligament (OPLL), as OPLL occasionally erodes to and through the dura. The se fistulas have been variously managed with gelfoam, dural substitutes sut ured in place, fibrin glue, lumbar drains, and lumboperitoneal shunts. Howe ver, more adequate dural repair is now feasible with the 1.4-mm microdural titanium stapler. METHODS A 59-year-old female with OPLL and moderate to severe myelopathy (Nurick Gr ade IV) had a C3-C7 anterior corpectomy with fusion using Orion plates foll owed by a C3-T1 posterior wiring and fusion with halo application. During t he anterior approach, a 5-mm CSF fistula at C4-C5 was directly repaired und er the operating microscope using a 1.4-mm microdural stapler, bovine peric ardial graft, and fibrin glue. Immediately postoperatively, a lumboperitone al shunt was also placed. RESULTS Postoperatively, her myelopathy improved to a mild to moderate level (Nuric k Grade IT). Her acute left deltoid plegia resolved within 3 months. CONCLUSIONS The 1.4-mm microdural stapler makes "watertight" closure of anterior cervic al CSF fistulas more feasible. (C) 1999 by Elsevier Science Inc.