Bone Wax Occlusion: A Simple Method for managing Cerebrospinal Fluid Leakage during Anterior Cervical Discectomy and Fusion Surgery

Abstract

Background Anterior cervical discectomy and fusion (ACDF) surgery is an important therapy for cervical degenerative diseases and trauma. Cerebrospinal fluid (CSF) leakage caused by intraoperative iatrogenic dural injury is an unusual but relatively troublesome complication. This retrospective study aimed to explore the effectiveness of using bone wax occlusion to manage iatrogenic CSF Leakage during ACDF surgery. Methods Retrospective study was performed. The main technical point of bone wax occlusion is as follows: After the CSF Leakage was found during ACDF surgery, complete occlusion of the anterior gap between the intervertebral cage and the upper and lower vertebral bodies with bone wax, followed the canal decompression and implantation of the fusion cage. The postoperative incision drainage catheter was indwelt or not according to the number of surgical segments, with no need for lumbar drainage. The effectiveness of the method was verified by reviewing the cases in which the CSF Leakage occurring during ACDF surgery from May 2019 to June 2022 was managed with bone wax occlusion. Results In total, 5 cases were found to have CSF Leakage due to unintentional iatrogenic dural injury during surgery and the method for bone wax occlusion was all adopted for them among 273 cases of ACDF surgery in 3 years. In 5cases, 3cases were two levels with incision draft tube, and left 2cases were single level without incision or lumbar drainage tube. There were no CSF Leakage related manifestations in all 5 cases after surgery, and bone wax occlusion was successful. Conclusion For CSF Leakage caused by unintentional dural injury during ACDF, bone wax occlusion is a simple and effective method.