C7-T1 Anterior Cervical Discectomy and Fusion for Cerebrospinal Fluid Leak Repair

Introduction: Cerebrospinal fluid (CSF) leaks can be spontaneous, traumatic, or iatrogenic and can result in potentially serious complications such as CSF hypotension leading to headaches and neurologic dysfunction. In most spontaneous cases, an epidural blood patch is successful in sealing the leak. However, in severe cases unresponsive to less invasive treatments, surgical intervention may be necessary. Anterior cervical discectomy and fusion (ACDF) is a rarely reported treatment for spontaneous CSF leak. Herein, we present a unique case of repair of spontaneous ventral CSF leak with ACDF to treat symptoms of CSF hypotension.

Methods: The patient presented with intractable, positional headaches and associated nausea/vomiting. Initial brain and spine imaging revealed a spontaneous CSF leak with signs of CSF hypotension and CSF buildup ventral to the spinal canal at the C5-T3 levels. A non-targeted blood patch provided minimal relief. Dynamic computed tomography (CT) myelogram demonstrated evidence of a focal CSF leak at the C7-T1 level associated with a ventral osteophyte. ACDF was performed in standard fashion with removal of the posterior longitudinal osteophytes. A small subcentimeter dural defect was noted at the C7-T1 level and repaired with two 7-0 prolene sutures followed by Tachosil fibrin sealant and Duraseal. Valsalva maneuver showed no further egress from the defect prior to graft and plate placement.

Results: Postoperatively, the patient noticed significant improvement in positional headaches. Recurrent frontal headaches were determined to be from prolonged cerebrospinal fluid loss, and gradually improved as expected. The patient sustained a recurrent laryngeal nerve injury resulting in minor dysphonia from surgery that was improving at six-week clinic follow-up.

Conclusion : Spontaneous cerebrospinal fluid leak can result in refractory intracranial hypotension leading to headaches and potential neurologic dysfunction. When unresponsive to traditional treatments such as blood patch, an anterior cervical approach can be utilized to repair accessible ventral spontaneous CSF leaks.